The effect of iron chelation therapy on overall survival in sickle cell disease and β-thalassemia: A systematic review

Am J Hematol. 2018 Jul;93(7):943-952. doi: 10.1002/ajh.25103. Epub 2018 Apr 28.

Abstract

Red blood cell transfusions have become standard of care for the prevention of life-threatening anemia in patients with β-thalassemia and sickle cell disease (SCD). However, frequent transfusions can lead to accumulation of iron that can result in liver cirrhosis, diabetes mellitus, arthritis, arrhythmias, cardiomyopathy, heart failure, and hypogonadotropic hypogonadism. Iron chelation therapy has been shown to reduce serum ferritin levels and liver iron content, but limitations of trial design have prevented any demonstration of improved survival. The objective of this systematic review was to investigate the impact of iron chelation therapy on overall and event-free survival in patients with β-thalassemia and SCD. Eighteen articles discussing survival in β-thalassemia and 3 in SCD were identified. Overall iron chelation therapy resulted in better overall survival, especially if it is instituted early and compliance is maintained. Comparative studies did not show any significant differences between available iron chelation agents, although there is evidence that deferiprone is better tolerated than deferoxamine and that compliance is more readily maintained with the newer oral drugs, deferiprone and deferasirox. Iron chelation therapy, particularly the second-generation oral agents, appears to be associated with improved overall and event-free survival in transfusion-dependent patients with β-thalassemia and patients with SCD.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Anemia, Sickle Cell / complications
  • Anemia, Sickle Cell / drug therapy*
  • Anemia, Sickle Cell / mortality
  • Blood Transfusion
  • Deferiprone / adverse effects
  • Deferiprone / therapeutic use
  • Deferoxamine / adverse effects
  • Deferoxamine / therapeutic use
  • Humans
  • Iron Chelating Agents / adverse effects
  • Iron Chelating Agents / therapeutic use*
  • Medication Adherence
  • Survival Analysis
  • beta-Thalassemia / drug therapy*
  • beta-Thalassemia / mortality

Substances

  • Iron Chelating Agents
  • Deferiprone
  • Deferoxamine