Iron Overload and Iron-Chelation Therapy in Patients with Myelodysplastyc Syndromes

Transfusion-dependency is an independent prognostic factor for survival in myelodysplastic syndromes (MDS). This negative impact is mainly due to the iron overload (IOL) consequent in large part to chronic transfusion therapy because of its detrimental effects on cardiac, hepatic and endocrine functions. The main tools useful for clinical diagnosis and monitoring of IOL should be serum ferritin, transferrin saturation and magnetic resonance imaging. If correctly evaluated, IOL is frequently observed in lower-risk MDS patients, and is more pronounced in longer surviving individuals. A detrimental role of IOL in MDS patients has been documented in several studies, showing a correlation with a shorter overall survival. Treatment of IOL with iron chelating therapy (ICT) has been shown to prevent at least in part these negative effects. The goal of ICT in MDS patients is to prevent and treat complications of IOL and to improve survival.