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Utility of labile plasma iron and transferrin saturation in addition to serum ferritin as iron overload markers in different underlying anemias before and after deferasirox treatment
Author(s) -
Porter John B.,
ElAlfy Mohsen,
Viprakasit Vip,
Giraudier Stephane,
Chan Lee Lee,
Lai Yongrong,
ElAli Ali,
Han Jackie,
Cappellini Maria D.
Publication year - 2016
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12540
Subject(s) - deferasirox , transferrin saturation , chelation therapy , medicine , gastroenterology , ferritin , myelodysplastic syndromes , transferrin , thalassemia , anemia , serum ferritin , bone marrow
Objectives Plasma markers in addition to serum ferritin ( SF ) may be useful for the assessment of iron overload; however, predictive utility may differ depending on underlying, transfusion‐dependent, anemias. Methods Data were collected before and after 1 year of deferasirox treatment (end of study; EOS ) from the large, 1‐year EPIC (Evaluation of Patients’ Iron Chelation with Exjade ® ) study. Trends were evaluated between liver iron concentration ( LIC ), transferrin saturation (TfSat), predose labile plasma iron ( LPI ) and their relationship to SF categories in 1530 patients: thalassemia major ( TM ; n = 1114), myelodysplastic syndromes ( MDS , n = 336), and sickle‐cell disease ( SCD , n = 80). Results Baseline and EOS SF values showed a clear and similar relationship to LIC for all disease groups. TfSat also showed a relationship to SF , most clearly in patients with SCD , where TfSat was lowest in the lowest relative SF category. Unlike SF or LIC , TfSat did not decrease at EOS in any disease group. Baseline LPI was raised in TM and MDS , but not in patients with SCD , decreasing at EOS in both patient groups. After 1 year of chelation therapy, there was a significant trend for greater LPI reduction in patients with TM achieving LIC <7 mg Fe/g dw ( P = 0.0137). Conclusions Despite limitations, SF showed the clearest relationship, of the plasma markers evaluated, to LIC before and after 1 year of deferasirox in patients with TM , MDS , and SCD . In patients with TM , changes in LPI with chelation show a significant relationship to EOS LIC and may provide an additional indicator of chelation response (clinicaltrials.gov identifier: NCT 00171821).