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Treating Iron Overload in Patients With Myelodysplastic Syndromes
National Comprehensive Cancer Network (NCCN) guidelines for the management of MDS state that the management of iron overload should be instituted for "relatively low-risk patients with excessive iron accumulation resulting from the number of red blood cell transfusions received" (1).
Patients most likely to benefit from management
Consensus recommendations developed by leading MDS clinicians and researchers describe the patients considered most likely to benefit from the monitoring and management of iron overload. These include (2):
- Patients with low-risk myelodysplastic syndromes (International Prognostic Scoring System: low- or intermediate-risk; World Health Organization: refractory anemia (RA), refractory anemia with ringed sideroblasts (RARS), and 5q- syndromes)
- Patients with documented stable MDS
- Transfusion-dependent patients
- Patients free of comorbidities that severely limit prognosis
- Candidates for allograft
These recommendations take note of the significant differences in survival expectancies among different MDS patient subtypes as reported by Malcovati and colleagues (3).
Significant differences in survival times among MDS subtypesSignificant differences in survival times among MDS subtypes
Half of all patients with refractory anemia can expect to survive over 9 years after diagnosis (108 months). Adapted with permission from Macovati, et al (3).
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National
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(NCCN) provides the guidelines for the management of MDS.
References
- (1) Greenberg PL. Myelodysplastic syndromes: iron overload consequences and current chelating therapies. J Natl Compr Canc Netw. 2006 Jan;4(1):91-6.
- (2) Gattermann N, Porter JB, Lopes LF, Seymour J. Consensus statement on iron overload in myelodysplastic syndromes. Hematol Oncol Clin North Am. 2005;19(Suppl 1):18-25.
- (3) Malcovati L, Porta MG, Pascutto C, et al. Prognostic factors and life expectancy in myelodysplastic syndromes classified according to WHO criteria: a basis for clinical decision making. J Clin Oncol. 2005;23(30):7594-603.