What is Iron Chelation for MDS?

Myelodysplastic syndromes (MDS) are a group of disorders where the bone marrow doesn’t produce enough healthy blood cells. This can lead to anemia (a lack of red blood cells) and, in some cases, progression to a more severe condition called acute myeloid leukemia (AML).

Patients with MDS are often categorized into different risk groups—low, intermediate, and high—based on factors like the number of abnormal cells in their bone marrow and their overall health. Low-risk MDS patients, in particular, may need regular blood transfusions to manage their anemia. However, these transfusions can lead to a buildup of iron in the body, known as iron overload.

How Does Iron Overload Happen?

Iron overload occurs when the body accumulates too much iron, mainly from frequent blood transfusions. Every unit of blood transfused contains iron, and since the body doesn’t have a natural way to get rid of excess iron, it can build up over time. This excess iron can be harmful, especially to vital organs like the liver, heart, and glands that regulate hormones.

In addition to transfusions, iron overload is also caused by the bone marrow’s inability to produce red blood cells effectively, which is a common issue in MDS. This situation can lead to even more iron being absorbed by the body, further increasing the risk of complications.

Why Is Iron Chelation Therapy Important?

Iron chelation therapy is a treatment designed to remove excess iron from the body. It works by binding to the extra iron and helping the body get rid of it through urine or other means. This therapy is particularly important for MDS patients who receive regular blood transfusions, as it helps prevent the damaging effects of iron overload on organs.

Research shows that iron chelation therapy can improve overall health in MDS patients. It reduces the need for blood transfusions, lowers the risk of the disease progressing to AML, and can even improve heart health. For patients undergoing stem cell transplants, managing iron levels with chelation therapy can lead to better outcomes, such as a lower risk of complications and improved survival rates.

When Should Iron Chelation Therapy Be Used?

Iron chelation therapy is often recommended for MDS patients who have received a significant number of blood transfusions and are at risk of iron overload. It is especially important for those undergoing stem cell transplantation, as iron overload can negatively impact the success of the transplant.

Doctors usually continue iron chelation therapy until the patient no longer needs transfusions or their iron levels return to normal. For MDS patients not undergoing a transplant, this therapy can still play a crucial role in managing their condition and improving their quality of life.

What Are the Side Effects of Iron Chelation Therapy?

There are common side effects when taking chelated iron, and all are central to the gastrointestinal tract: constipation, diarrhea, nausea, vomiting. Many side effects stop once the body adjusts to the iron. There are iron supplements that are non-chelated. But, chelated iron supplements are designed to be easier on your digestive system.

What Do Recent Studies Say About Iron Chelation for MDS? 

In a recent study presented at the ASH Annual Meeting 2023 on MDS and iron chelation. The study involved low-risk patients. Patients were 66 years and older. They were prescribed deferoxamine, deferasirox, or deferiprone.

The study showed that patients with iron chelation therapy: 

• Needed fewer transfusions.
• Experienced better overall survival.
• Had reduced risk of disease progression to AML.
• Had better cardiac outcomes.
• 79% achieved a substantial reduction in red blood cell units needed.

Conclusion

Iron chelation therapy is a vital part of treatment for MDS patients who rely on regular blood transfusions. By managing iron levels, this therapy helps protect vital organs, reduces the risk of complications, and supports better overall health. If you or a loved one with MDS receives regular transfusions, discussing iron chelation therapy with your healthcare provider could be an important step in managing the condition and improving long-term outcomes.

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Sources: 

• Angelucci E, Li J, Greenberg P, et al. Iron chelation in transfusion-dependent patients with low- to intermediate-1–risk myelodysplastic syndromes. Ann Intern Med. 
• Parisi, S., & Finelli, C. (2021). Prognostic factors and clinical considerations for iron chelation therapy in myelodysplastic syndrome patients. Journal of Blood Medicine, Volume 12, 1019–1030. https://doi.org/10.2147/jbm.s287876