Retrospective nationwide survey of Japanese patients with transfusion-dependent MDS and aplastic anemia highlights the negative impact of iron overload on morbidity/mortality

Masaaki Takatoku, Takashi Uchiyama, Shinichiro Okamoto, Yuzuru Kanakura, Kenichi Sawada, Masao Tomonaga, Shinji Nakao, Tatsutoshi Nakahata, Mine Harada, Takashi Murate, Keiya Ozawa

Research output: Contribution to journalArticle

153 Citations (Scopus)

Abstract

Objective: Myelodysplastic syndromes (MDS) and aplastic anemia (AA) are the most common anemias that require transfusion therapy in Japan. This retrospective survey investigated relationships between iron overload, chelation practices, and morbidity/mortality in patients with these diseases. Method: Medical histories of transfusion-dependent patients were assessed at transfusion onset, chelation onset, and study end. Results: Data were collected from 292 patients with MDS, AA, pure red cell aplasia, myelofibrosis, and other conditions. Patients received a mean of 61.5 red blood cell units during the previous year. Fewer than half (43%) of patients had previously received deferoxamine (DFO) therapy. Only 8.6% received daily/continuous DFO. In all, 75 deaths were reported, with cardiac and liver failure noted in 24.0 and 6.7% of cases. Of these, 97% had ferritin levels >1000 ng/mL. Abnormal cardiac and liver function was observed in 21.9% (14/64) and 84.6% (11/13) of all patients assessed. Effective chelation with DFO resulted in improved serum ferritin, liver enzymes, and fasting blood sugar. Conclusions: Mortality is higher in heavily iron-overloaded patients, with liver and cardiac dysfunction being the primary cause. Daily/continuous chelation therapy was effective at reducing iron burden and improving organ function. Chelation therapy should be initiated once serum ferritin levels exceed 1000 ng/mL.

Original languageEnglish
Pages (from-to)487-494
Number of pages8
JournalEuropean Journal of Haematology
Volume78
Issue number6
DOIs
Publication statusPublished - 2007 Jun

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Iron Overload
Aplastic Anemia
Myelodysplastic Syndromes
Morbidity
Mortality
Deferoxamine
Ferritins
Chelation Therapy
Iron
Pure Red-Cell Aplasia
Primary Myelofibrosis
Liver
Liver Failure
Surveys and Questionnaires
Serum
Blood Glucose
Liver Diseases
Anemia
Fasting
Japan

Keywords

  • Aplastic anemia
  • Deferoxamine
  • Iron chelation therapy
  • Myelodysplastic syndromes
  • Refractory anemias

ASJC Scopus subject areas

  • Hematology

Cite this

Retrospective nationwide survey of Japanese patients with transfusion-dependent MDS and aplastic anemia highlights the negative impact of iron overload on morbidity/mortality. / Takatoku, Masaaki; Uchiyama, Takashi; Okamoto, Shinichiro; Kanakura, Yuzuru; Sawada, Kenichi; Tomonaga, Masao; Nakao, Shinji; Nakahata, Tatsutoshi; Harada, Mine; Murate, Takashi; Ozawa, Keiya.

In: European Journal of Haematology, Vol. 78, No. 6, 06.2007, p. 487-494.

Research output: Contribution to journalArticle

Takatoku, Masaaki ; Uchiyama, Takashi ; Okamoto, Shinichiro ; Kanakura, Yuzuru ; Sawada, Kenichi ; Tomonaga, Masao ; Nakao, Shinji ; Nakahata, Tatsutoshi ; Harada, Mine ; Murate, Takashi ; Ozawa, Keiya. / Retrospective nationwide survey of Japanese patients with transfusion-dependent MDS and aplastic anemia highlights the negative impact of iron overload on morbidity/mortality. In: European Journal of Haematology. 2007 ; Vol. 78, No. 6. pp. 487-494.
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AU - Takatoku, Masaaki

AU - Uchiyama, Takashi

AU - Okamoto, Shinichiro

AU - Kanakura, Yuzuru

AU - Sawada, Kenichi

AU - Tomonaga, Masao

AU - Nakao, Shinji

AU - Nakahata, Tatsutoshi

AU - Harada, Mine

AU - Murate, Takashi

AU - Ozawa, Keiya

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N2 - Objective: Myelodysplastic syndromes (MDS) and aplastic anemia (AA) are the most common anemias that require transfusion therapy in Japan. This retrospective survey investigated relationships between iron overload, chelation practices, and morbidity/mortality in patients with these diseases. Method: Medical histories of transfusion-dependent patients were assessed at transfusion onset, chelation onset, and study end. Results: Data were collected from 292 patients with MDS, AA, pure red cell aplasia, myelofibrosis, and other conditions. Patients received a mean of 61.5 red blood cell units during the previous year. Fewer than half (43%) of patients had previously received deferoxamine (DFO) therapy. Only 8.6% received daily/continuous DFO. In all, 75 deaths were reported, with cardiac and liver failure noted in 24.0 and 6.7% of cases. Of these, 97% had ferritin levels >1000 ng/mL. Abnormal cardiac and liver function was observed in 21.9% (14/64) and 84.6% (11/13) of all patients assessed. Effective chelation with DFO resulted in improved serum ferritin, liver enzymes, and fasting blood sugar. Conclusions: Mortality is higher in heavily iron-overloaded patients, with liver and cardiac dysfunction being the primary cause. Daily/continuous chelation therapy was effective at reducing iron burden and improving organ function. Chelation therapy should be initiated once serum ferritin levels exceed 1000 ng/mL.

AB - Objective: Myelodysplastic syndromes (MDS) and aplastic anemia (AA) are the most common anemias that require transfusion therapy in Japan. This retrospective survey investigated relationships between iron overload, chelation practices, and morbidity/mortality in patients with these diseases. Method: Medical histories of transfusion-dependent patients were assessed at transfusion onset, chelation onset, and study end. Results: Data were collected from 292 patients with MDS, AA, pure red cell aplasia, myelofibrosis, and other conditions. Patients received a mean of 61.5 red blood cell units during the previous year. Fewer than half (43%) of patients had previously received deferoxamine (DFO) therapy. Only 8.6% received daily/continuous DFO. In all, 75 deaths were reported, with cardiac and liver failure noted in 24.0 and 6.7% of cases. Of these, 97% had ferritin levels >1000 ng/mL. Abnormal cardiac and liver function was observed in 21.9% (14/64) and 84.6% (11/13) of all patients assessed. Effective chelation with DFO resulted in improved serum ferritin, liver enzymes, and fasting blood sugar. Conclusions: Mortality is higher in heavily iron-overloaded patients, with liver and cardiac dysfunction being the primary cause. Daily/continuous chelation therapy was effective at reducing iron burden and improving organ function. Chelation therapy should be initiated once serum ferritin levels exceed 1000 ng/mL.

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