Page 133 - Haematologica March 2020

Iron chelation in lower risk MDS patients
We observed hematologic responses with all chelating agents.
A subgroup of chelated patients had an at least tempo- rary platelet response (22.9%) over time. Median platelet counts were in the normal range in both the chelated and non-chelated group.
Figure 6B demonstrates ferritin levels of chelated patients with and without a ferritin response and non- chelated patients. Fifteen (51.7%) of the 29 responding patients were treated with ESA and five (17.2%) were treated with lenalidomide. A subgroup of patients had a ferritin response (5.6-23.5%) over time. Responding patients showed ongoing mean serum ferritin levels of approximately 1000 mg/L, whereas non-responding chelated patients had mean ferritin values of approxi- mately 2100 m/L.
Chelated patients follow up
On average, chelated patients did not start therapy until 17 months after diagnosis (Table 1). Of the 199 chelated patients, at the time of the analysis, follow up was ongo- ing for 148 patients, for seven patients their disease had progressed to higher risk MDS/AML, 29 patients had died, and four have missing values of treatment dates (these four patients are still ongoing), nine patients had withdrawn from the study (four of these because of dis- ease progression and five after starting intensive treat- ment such as an allogeneic stem cell transplantation), and six were lost to follow up. Most patients (101 of the 148 ongoing patients) were receiving chelation at the time of the last report. Twenty of the 199 chelated patients switched from deferasirox to another chelating agent.
B
A
Figure 6. Trajectory analysis in chelated patients with and without response and for non- chelated patients. (A) Monthly red blood cell transfusion densi- ty for chelated patients with and without an erythroid response and for non-chelated patients. (B) Ferritin levels of patients with and without a ferritin
response, defined as decrease of ≥1000 mg/L or a drop of the serum ferritin value below 1000 mg/L, and for non- chelated patients.
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