Chronic iron overload and how it can be treated1
What is chronic iron overload?
Chronic iron overload occurs when the body’s limited iron storage capacities are exceeded over a sustained period of time. There is no natural mechanism to remove excess iron from the body, leading to iron build up within cells. This can damage the cell membrane resulting in fibrosis and cell death.
A cause of chronic iron overload is the use of regular blood transfusions. Blood transfusions can be a requirement for managing many chronic health conditions, such as MDS, SCD and thalassaemia. Iron overload can also occur in non-transfusion-dependent thalassaemia as a result of increased absorption of dietary iron through the GI tract.
How can iron overload be treated?
You may be able to reduce the level of iron in patients suffering from iron overload by treating them with ICT, such as EXJADE. This can prevent iron levels from reaching harmful concentrations.
Guidelines support the use of ICT in the following iron-overloaded patients
Current guidelines support the use of ICT for the treatment of iron overload in MDS, SCD and thalassaemia patients.
Lower-risk MDS patients2–5
Consider ICT in iron-overloaded patients with lower-risk MDS, who are intolerant of desferrioxamine.2
|British Committee for Standards in Haematology (BCSH)2|
|National Comprehensive Cancer Network (NCCN)3|
|European Society for Medical Oncology (ESMO)4|
|Scottish Medicines Consortium (SMC)5|
EXJADE is the only licensed agent for ICT in MDS when desferrioxamine therapy is contraindicated or inadequate.2
Consider ICT in iron-overloaded patients with SCD who are receiving intermittent/occasional simple transfusions over many years, on regular simple transfusions or on regular exchange transfusions.
|Sickle Cell Society|
Consideration of ICT is recommended in iron-overloaded patients with transfusion-dependent thalassaemia.
|United Kingdom Thalassaemia Society|
Abbreviations: BCSH, British Committee for Standards in Haematology; dw, dry weight; ICT, iron chelation therapy; IPSS, International Prognostic Scoring System; GI, gastrointestinal; LIC, liver iron concentration; MDS, myelodysplastic syndromes; MRI, magnetic resonance imaging; NCCN, National Comprehensive Cancer Network; NHS, National Health Service; PACE, Patient and Clinician Engagement; RA, refectory anaemia; RARS, refractory anaemia with ringed sideroblasts; RBC, red blood cell; SCD, sickle cell disease; SMC, Scottish Medicines Consortium; T2*, T2-star weighted imaging; WHO, World Health Organization.
- Cappellini MD, et al. Guidelines for the management of transfusion dependent thalassaemia (TDT). 3rd ed. Nicosia, Cyprus: Thalassaemia International Federation; 2014.
- Killick S, et al. Guidelines for the diagnosis and management of adult myelodysplastic syndromes. Br J Haematol 2014;164:503–525.
- NCCN. Myelodysplastic syndromes. Version 2. 2018.
- Fenaux, et al. Myelodysplastic syndromes: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014;25 (Supplement 3): iii57–iii69.
- SMC. Re-submission: Deferasirox 125mg, 250mg, 500mg dispersible tablets (EXJADE®). SMC No. (347/07). 2016.
- Sickle Cell Society. Standards for clinical care of adults with sickle cell disease in the UK, 2nd Edition, 2018.
- United Kingdom Thalassaemia Society. Standards for the clinical care of children and adults with thalassaemia in the UK, 3rd Edition, 2016.