Impact of treatment with iron chelation therapy in patients with lower-risk myelodysplastic syndromes participating in the European MDS registry.

Fecha de publicación: 01/03/2020 Fecha Ahead of Print: 05/07/2019

Autores de IIS La Fe

Guillermo Sanz Santillana

Autor

Participantes ajenos a IIS La Fe

Hoeks M
Yu G
Langemeijer S
Crouch S
de Swart L
Fenaux P
Symeonidis A
Cermák J
Hellström-Lindberg E
Stauder R
Holm MS
Mittelman M
Madry K
Malcovati L
Tatic A
Almeida AM
Germing U
Savic A
Gredelj Šimec N
Culligan D
Itzykson R
Guerci-Bresler A
Slama B
van de Loosdrecht A
van Marrewijk C
Droste J
Blijlevens N
van Kraaij M
Bowen D
de Witte T
Smith A
EUMDS Registry Participants

Grupos

Hematología y Hemoterapia

Investigador Principal

Javier De La Rubia Comos

Abstract

Iron overload due to red blood cell transfusions is associated with morbidity and mortality in lower-risk myelodysplastic syndrome patients. Many studies suggested improved survival after iron chelation therapy, but valid data are limited. The aim of this study was to assess the effect of iron chelation on overall survival and hematological improvement in lower-risk myelodysplastic syndrome patients in the European MDS registry. We compared chelated patients with a contemporary, non-chelated control group within the European MDS registry, that met the eligibility criteria for starting iron chelation. A Cox proportional hazards model was used to assess overall survival, treating receipt of chelation as a time-varying variable. Additionally, chelated and non-chelated patients were compared using a propensity-score matched model. Of 2200 patients, 224 received iron chelation. The hazard ratio and 95% confidence interval for overall survival for chelated patients, adjusted for age, sex, comorbidity, performance status, cumulative red blood cell transfusions, IPSS-R, and presence of ringed sideroblasts was 0.50 (0.34-0.74). The propensity-score analysis, matched for age, sex, country, red blood cell transfusion intensity, ferritin level, comorbidity, performance status, and IPSS-R and additionally corrected for cumulative red blood cell transfusions and presence of ringed sideroblasts, demonstrated a significantly improved overall survival for chelated patients with a hazard ratio of 0.42 (0.27-0.63) compared to non-chelated patients. Up to 39% of chelated patients reached an erythroid response. In conclusion, our results suggest that iron chelation may improve overall survival and hematopoiesis in transfused lower-risk myelodysplastic syndrome patients. This trial was registered at www.clinicaltrials.gov as #NCT00600860.

Datos de la publicación

ISSN/ISSNe:: 0390-6078, 1592-8721
Tipo:: Article
Páginas:: 640-651
DOI:: 10.3324/haematol.2018.212332
Factor de Impacto:: 2,782 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Métricas

Filiaciones

Hoeks M:: Centre for Clinical Transfusion Research, Sanguine Research, Leiden, The Netherlands
Yu G:: Department of Health Sciences, University of York, York, United Kingdom
Langemeijer S:: Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands
Crouch S:: Department of Health Sciences, University of York, York, United Kingdom
de Swart L:: Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands
Fenaux P:: Service d'Hématologie, Hôpital Saint-Louis and Université Paris 7, Paris, France
Symeonidis A:: Department of Medicine, University of Patras Medical School, Patras, Greece
Cermák J:: Dept. of Clinical Hematology, Inst. of Hematology Blood Transfusion, Praha, Czech Republic
Hellström-Lindberg E:: Department of Medicine, Karolinska Institutet, Stockholm, Sweden
Sanz G:: Department of Haematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
Stauder R:: Dept. of Haematology and Oncology, Innsbruck Medical University, Innsbruck, Austria
Holm MS:: Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
Mittelman M:: Tel Aviv Sourasky (Ichilov) Medical Center and Sackler Medical Faculty, Tel Aviv University, Israel
Madry K:: Dept. of Haematology, Oncology and Internal Medicine, Warszawa Medical University, Warszawa, Poland
Malcovati L:: Department of Hematology Oncology, Policlinico San Matteo, University of Pavia, Italy
Tatic A:: Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
Almeida AM:: Department of Hematology, Hospital da Luz, Lisbon, Portugal
Germing U:: Dept. of Haematology, Oncology and Clinical Immunology, Universitätsklinik Dusseldorf, Germany
Savic A:: Clinical Center of Vojvodina, University of Novi Sad, Novi Sad, Serbia
Gredelj Šimec N:: Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia
Culligan D:: Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
Itzykson R:: Service Hématologie Seniors, Hôpital Saint-Louis, Université Paris 7, France
Guerci-Bresler A:: Service Hematologie, Centre Hospitalier Universitaire Brabois Vandoeuvre, Nancy, France
Slama B:: Service Hématologie, Centre Hospitalier d'Avignon, Avignon, France
van de Loosdrecht A:: Dept. of Hematology, Cancer Center Amsterdam VU University Medical Center, The Netherlands
van Marrewijk C:: Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands
Droste J:: Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands
Blijlevens N:: Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands
van Kraaij M:: Unit Transfusion Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands
Bowen D:: St. James's Institute of Oncology, Leeds Teaching Hospitals, Leeds, United Kingdom
de Witte T:: Department of Tumor Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
Smith A:: Department of Health Sciences, University of York, York, United Kingdom