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Crit Rev Oncol Hematol. 2017 Sep;117:57-66. doi: 10.1016/j.critrevonc.2017.07.002. Epub 2017 Jul 12.

Overcoming barriers to treating iron overload in patients with lower-risk myelodysplastic syndrome.

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Department of Hematology, Yale Cancer Center, New Haven, CT, United States. Electronic address:
Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, United States.
Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL, United States.


Myelodysplastic syndromes (MDS) constitute a group of heterogeneous hematopoietic neoplasms characterized by ineffective erythropoiesis, anemia, and/or cytopenias. Supportive care for patients with MDS involves frequent red blood cell transfusions, which places patients with ongoing transfusional dependence (TD) at risk for iron overload (IO). Development of IO and tissue iron deposition can increase the risk of cardiac, hepatic, and endocrine toxicities, infection, and progression to acute myeloid leukemia. Iron chelation therapy (ICT) is an option for lower-risk MDS patients to reduce their degree of IO and possibly improve survival; use of these agents in thalassemia patients with TD and IO has been associated with reduced IO-associated complications and better survival. At present, there are several barriers to the regular use of ICT, such as a lack of randomized trial evidence and consistent guidance on diagnosis of IO and when to implement ICT, as well as barriers in adherence to/tolerability of ICT.


Acute myeloid leukemia; Iron chelation; Iron overload; Myelodysplastic syndrome

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