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Deviating from safety guidelines during deferiprone therapy in clinical practice may not be associated with higher risk of agranulocytosis
Author(s) -
Elalfy Mohssen,
Wali Yasser A.,
Qari Mohamad,
Al Damanhouri Ghazi,
AlTonbary Youssef,
Yazman Dilek,
Al Hawsawi Zakaria,
Karakas Zeynep,
Kilinc Yurdanur,
Yesilipek M. Akif,
Badr Mohamed,
Elsafy Usama,
Salama Mostafa,
Abdel Rahman Yousryeia,
Shebl Shebl,
Stilman Anne,
Toiber Temin Noemi,
Tricta Fernando
Publication year - 2014
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.24920
Subject(s) - deferiprone , medicine , neutropenia , guideline , pediatrics , intensive care medicine , absolute neutrophil count , thalassemia , chemotherapy , pathology
Background A risk associated with the iron chelator deferiprone is the development of neutropenia or agranulocytosis. Accordingly, the product label recommends weekly blood monitoring and immediate interruption of treatment upon detection of an absolute neutrophil count (ANC) <1.5 × 10 9 /L, out of concern that continued therapy might lead to a more severe drop. However, it is uncertain how these recommendations are followed under real‐life conditions and, if they are not followed, whether continuation of therapy results in increased incidence of agranulocytosis. Procedure This non‐interventional surveillance program assessed the monitoring of deferiprone therapy in clinical practice. A total of 294 patients with transfusion‐dependent anemias received deferiprone, as monotherapy or with another chelator, for up to 1 year. The participating physicians were not given any instructions about treatment and monitoring beyond being referred to the information in the package insert. Results ANC monitoring was conducted at an average interval of 5 ± 4 weeks, and deferiprone was not always interrupted upon detection of neutropenia. One patient (0.3%) experienced agranulocytosis, and nine others (3%) experienced a total of 11 episodes of neutropenia. All neutropenia episodes resolved; median time to resolution was similar whether or not treatment was interrupted; and no case of neutropenia progressed to agranulocytosis. Conclusions These data indicate that less frequent ANC monitoring and continuation of deferiprone therapy during neutropenia are not associated with prolonged neutropenia or with progression to agranulocytosis. Pediatr Blood Cancer 2014;61:879–884. © 2014 Wiley Periodicals, Inc.