Iron Chelation is Feasible for MDS, Iron Overload Management

In at least certain patients who have transfusion-dependent myelodysplastic syndromes (MDS) and iron overload, iron chelation therapy is a reasonable management approach. This is according to Heather Leitch, MD, PhD, FRCPC, of St. Paul’s Hospital in Vancouver, and Rena Buckstein, MD, FRCPC, of Odette Cancer Center in Toronto, who recently published an article on this subject in Blood.

According to the authors, a debate currently exists about whether and how to use iron chelation therapy in care of patients who have transfusion-dependent MDS and iron overload. Although MDS has several disease characteristics which can complicate iron chelation therapy use in patients, they argue there is a population for whom this treatment is advisable.

“Since 50% of patients will ultimately become red blood cell transfusion dependent and develop transfusional iron overload, iron chelation therapy should be considered in some,” the authors write.

Supported by case information, the authors detail which adult patients iron chelation therapy should be considered for, as well as how to clinically evaluate iron toxicity and overload in these patients. They then overview the clinical options currently available for such therapy and explain how best to employ them in management, perform monitoring, and account for side effects.

“Given challenges with the use of iron chelators, we suggest the nuances to be considered when planning chelation initiation include the rate of iron accumulation, the presence of organ iron and/or dysfunction, and detectable indicators of oxidative stress” the authors advised.

Reference

Leitch HA, Buckstein RJ. How I treat iron overload in adult myelodysplastic syndrome. Blood. doi:10.1182/blood.2023022501