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Leuk Res. 2018 Nov;74:21-41. doi: 10.1016/j.leukres.2018.09.005. Epub 2018 Sep 19.

Iron overload in myelodysplastic syndromes: Evidence based guidelines from the Canadian consortium on MDS.

Author information

1
Hematology, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada. Electronic address: hleitch@providencehematology.com.
2
Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
3
Hematology/Oncology, University of Alberta, Edmonton, Alberta, Canada.
4
Leukemia/BMT Program of British Columbia, Division of Hematology, Vancouver, BC, Canada.
5
Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
6
McMaster University, Hamilton, Ontario, Canada.
7
Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.
8
Centre d'Oncologie, Dr-Leon-Richard, Moncton, New Brunswick, Canada.
9
Hematology/Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada.
10
Hematology Department, Centre Hospitalier Universitaire, Laval University, Quebec, QC, Canada.
11
Department of Medicine/Hematology, Foothills Medical Centre, Calgary, Alberta, Canada.
12
McGill University Health Centre, Montreal, Quebec, Canada.
13
Sir Mortimer B Davis Hospital, McGill University, Montreal, Quebec, Canada.
14
Saskatoon Cancer Center, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

Abstract

In 2008 the first evidence-based Canadian consensus guideline addressing the diagnosis, monitoring and management of transfusional iron overload in patients with myelodysplastic syndromes (MDS) was published. The Canadian Consortium on MDS, comprised of hematologists from across Canada with a clinical and academic interest in MDS, reconvened to update these guidelines. A literature search was updated in 2017; topics reviewed include mechanisms of iron overload induced cellular damage, evidence for clinical endpoints impacted by iron overload including organ dysfunction, infections, marrow failure, overall survival, acute myeloid leukemia progression, and endpoints around hematopoietic stem-cell transplant. Evidence for an impact of iron reduction on the same endpoints is discussed, guidelines are updated, and areas identified where evidence is suboptimal. The guidelines address common questions around the diagnosis, workup and management of iron overload in clinical practice, and take the approach of who, when, why and how to treat iron overload in MDS. Practical recommendations for treatment and monitoring are made. Evidence levels and grading of recommendations are provided for all clinical endpoints examined.

KEYWORDS:

Clinical outcomes; Iron chelation therapy; Iron overload; MDS; Myelodysplastic syndromes

PMID:
30286330
DOI:
10.1016/j.leukres.2018.09.005
[Indexed for MEDLINE]

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