Long-term chelation therapy with deferasirox: effects on cardiac iron overload measured by T2* MRI

We report the long-term effects of deferasirox 10-30 mg/kg/day on cardiac iron overload in a case series of five patients with transfusion-dependent beta-thalassaemia major who underwent up to 5 years of chelation therapy. Iron overload was monitored by multislice multi-echo T2* magnetic resonance imaging (MRI). Overall, T2* MRI showed a decrease from baseline in cardiac iron levels in all patients during treatment with deferasirox (baseline T2* levels 13-24 ms; final T2* levels 21-41 ms). The improvement in T2* values correlated with maintenance of left ventricular ejection fraction (LVEF) [baseline LVEF values 56-61%; final LVEF values 57-70%]. Deferasirox chelation treatment regimen was well tolerated and adherence to the regimen was good. In conclusion, this case series suggests that deferasirox may decrease cardiac iron overload and maintain stable LVEF over the long term. Moreover, it emphasizes the importance of T2* multislice multi-echo MRI in the monitoring of cardiac iron overload.