Utilization Patterns and Outcomes From Iron Chelation Therapy in Elderly Patients With Myelodysplastic Syndromes: A...

Area of Science:

• Hematology
• Oncology
• Geriatric Medicine

Background:

• Iron overload from red blood cell (RBC) transfusions is a major concern in myelodysplastic syndromes (MDS), contributing to morbidity and mortality.
• Evidence for the efficacy of iron chelation therapy (ICT) in elderly MDS patients is limited.

Purpose of the Study:

• To evaluate the utilization and outcomes of ICT in elderly MDS patients using real-world data.
• To assess the association of ICT with survival, acute myeloid leukemia (AML) development, and iron-related complications.

Main Methods:

• Analysis of the U.S. SEER-Medicare database (2007-2017) for MDS patients aged ≥66 with ≥2-year survival.
• Eligibility for ICT defined by documented iron overload and/or significant RBC transfusion history.
• Outcomes assessed using multivariable Cox hazards models and propensity score matching.

Main Results:

• 15.3% of eligible elderly MDS patients received ICT, with deferasirox and deferoxamine being the most common agents.
• ICT use was predicted by specific histological features and concomitant therapies (e.g., hypomethylating agents, lenalidomide).
• Among transfusion-dependent patients, ICT was associated with a 47%-48% reduced risk of mortality, 43%-49% reduced risk of AML, and 23%-32% reduced risk of adverse cardiac outcomes.

Conclusions:

• Iron chelation therapy (ICT) is associated with improved survival and reduced risks of AML and cardiac complications in elderly MDS patients.
• The findings suggest ICT is beneficial for managing iron overload in this vulnerable population, despite limited prior evidence.
• Further research may explore optimal ICT strategies for elderly MDS patients.