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- Title
Iron Chelation Therapy: Past, Present, and Future Prospects.
- Authors
Hoffbrand, Victor
- Abstract
Iron chelation therapy became effective for treatment of patients with refractory anemias, dependent on blood transfusions for survival, with the introduction of regular subcutaneous infusions of desferrioxamine (deferoxamine) in 1976. This drug improved freedom from side effects of iron overload on the heart, liver, and endocrine glands and overall survival in thalassemia major in many but not all compliant patients. Its position as a gold standard for iron chelation therapy is now challenged by the newer oral agents deferiprone (introduced in 1987) and deferasirox (in 2002) that have increased compliance with iron chelation therapy, enabled this to be given every day of the week, and have provided the possibility of chelation for patients for whom deferoxamine is inappropriate because of side effects or noncompliance. Morbidity and mortality due to transfusional iron overload have decreased substantially over the past 10 years in Italy, Cyprus, the UK, and many other countries. The introduction of the T2* MRI technique to measure cardiac iron has made a major contribution to this improvement. Combined chelation with deferiprone and desferrioxamine is widely used and trials of combinations of deferoxamine or deferiprone with deferasirox are in progress. The availability of oral chelators has also led trials of iron chelation therapy in good risk, transfusion-dependent patients with myelodysplasia and other hematological malignancies as well as trials of iron chelation therapy in some neurological diseases such as Friedrich's ataxia where there is local accumulation of iron in the brain. The results of long-term, prospective, randomized iron chelator studies in these disorders are awaited.
- Subjects
THERAPEUTIC use of iron chelates; APLASTIC anemia; BLOOD transfusion; DEFERASIROX; IRON in the body; THALASSEMIA; MAGNETIC resonance imaging
- Publication
European Journal of Clinical & Medical Oncology, 2010, Vol 2, Issue 3, p1
- ISSN
1759-8958
- Publication type
Article