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Blood Rev. 2018 Sep;32(5):368-377. doi: 10.1016/j.blre.2018.03.002. Epub 2018 Mar 8.

To chelate or not to chelate in MDS: That is the question!

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Section of Hematology, Department of Medicine, Yale University, Yale Cancer Center, New Haven, CT, USA. Electronic address:
Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA. Electronic address:


Myelodysplastic syndromes (MDS) are a heterogeneous group of hemopathies that exhibit physical manifestations with clinical consequences of bone marrow failure and inherent risk of progression to acute myeloid leukemia. Iron overload (IO) is common in MDS due to chronic transfusion support and disease-related alterations in iron metabolism. IO has been conclusively associated with inferior outcomes among MDS patients. Despite lack of randomized trials showing a survival impact of iron chelation therapy (ICT), ICT is recommended by experts and guidelines for select MDS patients with IO and is often used. The availability of effective oral ICT agents has reignited the controversy regarding ICT use in patients with MDS and IO. Here we summarize the studies evaluating the value of ICT in MDS and suggest a practical approach for use of these therapies. We also highlight controversies regarding use of ICT in MDS and discuss some ongoing efforts to answer these questions.


Deferasirox; Deferiprone; Deferoxamine; Iron chelation; Myelodysplastic syndromes; Transfusion

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