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Transfusional Iron Overload in Children With Leukemia
Nihal Karadaş1, Erkam Dolapçi1, Ayshe Gadashova1
1Department of Pediatric Hematology, Ege University Faculty of Medicine, Children's Hospital, Izmir, Turkey.
Insights
Pediatric leukemia patients often experience iron overload due to blood transfusions. Iron chelation therapy with deferasirox is safe and effective in managing this condition, reducing iron burden with mild side effects.
Area of Science:
- Hematology
- Pediatric Oncology
- Pharmacology
Background:
- Iron overload is a significant concern in pediatric patients with leukemia.
- Chronic blood transfusions in leukemia patients can lead to excessive iron accumulation.
- Assessing iron status is crucial for managing treatment-related complications.
Purpose of the Study:
- To examine iron overload in pediatric leukemia patients.
- To evaluate the safety and efficacy of iron chelation therapy using deferasirox.
- To identify predictors for the need of chelation therapy.
Main Methods:
- Retrospective screening of medical records for 208 children with acute leukemia.
- Comparison of iron status, packed red blood cell (pRBC) volume, and transfusion history between patients receiving and not receiving deferasirox.
- Determination of cut-off values for serum ferritin, cumulative pRBC volume, and pRBC transfusion number to predict chelation need.
Main Results:
- 193 patients were included; 44 (22.8%) received iron chelation therapy.
- Patients requiring chelation had significantly higher pRBC transfusions, cumulative pRBC volumes, and ferritin levels.
- Established predictive cut-off values for serum ferritin (1952 mcg/L), cumulative pRBC volume (145 mL/kg), and pRBC transfusion number (12).
- Deferasirox demonstrated effectiveness and safety in reducing iron burden, with only mild-to-moderate adverse effects.
Conclusions:
- Iron overload is a common complication in pediatric leukemia patients.
- The number of packed red blood cell transfusions and cumulative transfusional volume are associated with iron overload.
- Iron chelation therapy with deferasirox is a safe and effective strategy for managing iron overload in this population.
Introduction:
This study examines iron overload and assesses the safety and efficacy of chelation therapy in patients with leukemia.
Methods:
The medical records of 208 children with acute leukemia were retrospectively screened. The iron status at diagnosis, cumulative packed red blood cell (pRBC) volume, number of pRBC transfusions, and iron burden of the patients at the end of intravenous chemotherapy were compared between patients who were and were not given iron chelation treatment with deferasirox.
Results:
A total of 193 patients with leukemia were enrolled in the study. The average age was 65.5 months, and 56% were male. The patients were grouped according to receiving chelation therapy. Forty-four patients (22.8%) received iron chelation therapy. High-risk patients needed significantly more chelation treatment (p < 0.001). The number of pRBC transfusions, cumulative pRBC volumes, and ferritin values at the beginning of maintenance therapy were significantly higher in patients who received chelation treatment (p < 0.001). The cut-off values for the predictivity of serum ferritin, cumulative pRBC volume, and number of pRBC transfusions in chelation need were determined as 1952 mcg/L, 145 mL/kg, and 12 times, respectively (0.933, 95% confidence interval [CI]: [0.887-0.964], p < 0.001; 0.942, 95% CI: [0.899-0.970], p < 0.001; 0.903, 95% CI: [0.853-0.941], p < 0.001, respectively). Deferasirox was effective and safe in reducing iron burden. Only mild-to-moderate adverse effects were observed.
Conclusion:
Iron overload can develop in pediatric patients with leukemia and is associated with number of pRBC transfusions and cumulative pRBC transfusional volume.
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