Longitudinal changes in pancreatic iron burden in non-transfusion-dependent thalassemia: A multicenter MRI study

We evaluated 18-month changes in pancreatic iron burden and its relationship with systemic iron balance and glucose metabolism in non-transfusion-dependent thalassemia (NTDT) patients. We retrospectively studied 32 non-transfused (NT) and 57 regularly transfused (RT) NTDT patients enrolled in the Extension-Myocardial Iron Overload in Thalassemia project. Iron overload (IO) was assessed by T2* magnetic resonance imaging and glucose metabolism by oral glucose tolerance test. At baseline, iron chelation therapy was administered in 40.6% of NT-NTDT and 98.2% of RT-NTDT patients. No significant overall changes in pancreatic iron burden were observed in either group. New-onset pancreatic IO occurred in 22.7% of NT and 35.3% of RT patients with normal baseline pancreatic T2* values. Longitudinal changes in pancreatic iron burden were not associated with age, serum ferritin, baseline liver iron concentration (LIC), or changes in LIC, but were inversely related to baseline pancreatic T2* values. In RT patients, pancreatic iron changes were not influenced by baseline glucose metabolism status. After adjustment for baseline pancreatic T2*, NT-NTDT patients showed a greater increase in global pancreatic T2* than RT-NTDT patients. This difference was more pronounced among patients with baseline pancreatic IO. In NTDT patients, pancreatic iron burden showed slow longitudinal changes that were primarily driven by baseline pancreatic iron status rather than systemic iron balance, with a more favorable evolution in non-transfused than in regularly transfused patients.