Impact of treatment with iron chelation therapy in patients with lower-risk myelodysplastic syndromes participating in the European MDS registry

EUMDS Registry Participants; Alexandra Gwen Smith

doi:10.3324/haematol.2018.212332

Impact of treatment with iron chelation therapy in patients with lower-risk myelodysplastic syndromes participating in the European MDS registry

EUMDS Registry Participants, Alexandra Gwen Smith

Health Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

Iron overload due to red blood cell transfusions is associated with morbidity and mortality in lower-risk myelodysplastic syndrome patients. Many studies suggested improved survival after iron chelation therapy, but valid data are limited. The aim of this study was to assess the effect of iron chelation on overall survival and hematological improvement in lower-risk myelodysplastic syndrome patients in the European MDS registry. We compared chelated patients with a contemporary, non-chelated control group within the European MDS registry, that met the eligibility criteria for starting iron chelation. A Cox proportional hazards model was used to assess overall survival, treating receipt of chelation as a time-varying variable. Additionally, chelated and non-chelated patients were compared using a propensity-score matched model. Of 2200 patients, 224 received iron chelation. The hazard ratio and 95% confidence interval for overall survival for chelated patients, adjusted for age, sex, comorbidity, performance status, cumulative red blood cell transfusions, IPSS-R, and presence of ringed sideroblasts was 0.50 (0.34-0.74). The propensity-score analysis, matched for age, sex, country, red blood cell transfusion intensity, ferritin level, comorbidity, performance status, and IPSS-R and additionally corrected for cumulative red blood cell transfusions and presence of ringed sideroblasts, demonstrated a significantly improved overall survival for chelated patients with a hazard ratio of 0.42 (0.27-0.63) compared to non-chelated patients. Up to 39% of chelated patients reached an erythroid response. In conclusion, our results suggest that iron chelation may improve overall survival and hematopoiesis in transfused lower-risk myelodysplastic syndrome patients. This trial was registered at www.clinicaltrials.gov as #NCT00600860.

Original language	English
Pages (from-to)	640-651
Number of pages	11
Journal	Haematologica-The hematology journal
Volume	105
Issue number	3
Early online date	5 Jul 2019
DOIs	https://doi.org/10.3324/haematol.2018.212332
Publication status	Published - 31 Mar 2020

Bibliographical note

Copyright © 2019, Ferrata Storti Foundation.
Please email [email protected] for any changes made to this PURE entry.

Access to Document

10.3324/haematol.2018.212332

haematol.2018.212332.full
Copyright © 2019, Ferrata Storti Foundation.
Final published version, 2.29 MBLicence: CC BY

Alex Smith
- alexandra.smithyork.acuk
- Health Sciences - Professor
Person: Research

Cite this

@article{b7cb858f833c493cb4aa9e8add8140e4,

title = "Impact of treatment with iron chelation therapy in patients with lower-risk myelodysplastic syndromes participating in the European MDS registry",

abstract = "Iron overload due to red blood cell transfusions is associated with morbidity and mortality in lower-risk myelodysplastic syndrome patients. Many studies suggested improved survival after iron chelation therapy, but valid data are limited. The aim of this study was to assess the effect of iron chelation on overall survival and hematological improvement in lower-risk myelodysplastic syndrome patients in the European MDS registry. We compared chelated patients with a contemporary, non-chelated control group within the European MDS registry, that met the eligibility criteria for starting iron chelation. A Cox proportional hazards model was used to assess overall survival, treating receipt of chelation as a time-varying variable. Additionally, chelated and non-chelated patients were compared using a propensity-score matched model. Of 2200 patients, 224 received iron chelation. The hazard ratio and 95% confidence interval for overall survival for chelated patients, adjusted for age, sex, comorbidity, performance status, cumulative red blood cell transfusions, IPSS-R, and presence of ringed sideroblasts was 0.50 (0.34-0.74). The propensity-score analysis, matched for age, sex, country, red blood cell transfusion intensity, ferritin level, comorbidity, performance status, and IPSS-R and additionally corrected for cumulative red blood cell transfusions and presence of ringed sideroblasts, demonstrated a significantly improved overall survival for chelated patients with a hazard ratio of 0.42 (0.27-0.63) compared to non-chelated patients. Up to 39% of chelated patients reached an erythroid response. In conclusion, our results suggest that iron chelation may improve overall survival and hematopoiesis in transfused lower-risk myelodysplastic syndrome patients. This trial was registered at www.clinicaltrials.gov as #NCT00600860.",

author = "{EUMDS Registry Participants} and Marlijn Hoeks and Ge Yu and Saskia Langemeijer and Simon Crouch and {de Swart}, Louise and Pierre Fenaux and Argiris Symeonidis and Jaroslav {\v C}erm{\'a}k and Eva Hellstr{\"o}m-Lindberg and Guillermo Sanz and Reinhard Stauder and Holm, {Mette Skov} and Moshe Mittelman and Krzysztof M{\c a}dry and Luca Malcovati and Aurelia Tatic and Almeida, {Antonio Medina} and Ulrich Germing and Aleksandar Savic and {Gredelj {\v S}imec}, Njeto{\v c}ka and Dominic Culligan and Raphael Itzykson and Agnes Guerci-Bresler and Borhane Slama and Jackie Droste and {van Marrewijk}, Corine and {van de Loosdrecht}, Arjan and Nicole Blijlevens and {van Kraaij}, Marian and David Bowen and {de Witte}, Theo and Smith, {Alexandra Gwen}",

note = "Copyright {\textcopyright} 2019, Ferrata Storti Foundation. Please email [email protected] for any changes made to this PURE entry.",

year = "2020",

month = mar,

day = "31",

doi = "10.3324/haematol.2018.212332",

language = "English",

volume = "105",

pages = "640--651",

journal = "Haematologica-The hematology journal",

issn = "0390-6078",

publisher = "Ferrata Storti Foundation",

number = "3",

}

TY - JOUR

T1 - Impact of treatment with iron chelation therapy in patients with lower-risk myelodysplastic syndromes participating in the European MDS registry

AU - EUMDS Registry Participants

AU - Hoeks, Marlijn

AU - Yu, Ge

AU - Langemeijer, Saskia

AU - Crouch, Simon

AU - de Swart, Louise

AU - Fenaux, Pierre

AU - Symeonidis, Argiris

AU - Čermák, Jaroslav

AU - Hellström-Lindberg, Eva

AU - Sanz, Guillermo

AU - Stauder, Reinhard

AU - Holm, Mette Skov

AU - Mittelman, Moshe

AU - Mądry, Krzysztof

AU - Malcovati, Luca

AU - Tatic, Aurelia

AU - Almeida, Antonio Medina

AU - Germing, Ulrich

AU - Savic, Aleksandar

AU - Gredelj Šimec, Njetočka

AU - Culligan, Dominic

AU - Itzykson, Raphael

AU - Guerci-Bresler, Agnes

AU - Slama, Borhane

AU - Droste, Jackie

AU - van Marrewijk, Corine

AU - van de Loosdrecht, Arjan

AU - Blijlevens, Nicole

AU - van Kraaij, Marian

AU - Bowen, David

AU - de Witte, Theo

AU - Smith, Alexandra Gwen

PY - 2020/3/31

Y1 - 2020/3/31

N2 - Iron overload due to red blood cell transfusions is associated with morbidity and mortality in lower-risk myelodysplastic syndrome patients. Many studies suggested improved survival after iron chelation therapy, but valid data are limited. The aim of this study was to assess the effect of iron chelation on overall survival and hematological improvement in lower-risk myelodysplastic syndrome patients in the European MDS registry. We compared chelated patients with a contemporary, non-chelated control group within the European MDS registry, that met the eligibility criteria for starting iron chelation. A Cox proportional hazards model was used to assess overall survival, treating receipt of chelation as a time-varying variable. Additionally, chelated and non-chelated patients were compared using a propensity-score matched model. Of 2200 patients, 224 received iron chelation. The hazard ratio and 95% confidence interval for overall survival for chelated patients, adjusted for age, sex, comorbidity, performance status, cumulative red blood cell transfusions, IPSS-R, and presence of ringed sideroblasts was 0.50 (0.34-0.74). The propensity-score analysis, matched for age, sex, country, red blood cell transfusion intensity, ferritin level, comorbidity, performance status, and IPSS-R and additionally corrected for cumulative red blood cell transfusions and presence of ringed sideroblasts, demonstrated a significantly improved overall survival for chelated patients with a hazard ratio of 0.42 (0.27-0.63) compared to non-chelated patients. Up to 39% of chelated patients reached an erythroid response. In conclusion, our results suggest that iron chelation may improve overall survival and hematopoiesis in transfused lower-risk myelodysplastic syndrome patients. This trial was registered at www.clinicaltrials.gov as #NCT00600860.

AB - Iron overload due to red blood cell transfusions is associated with morbidity and mortality in lower-risk myelodysplastic syndrome patients. Many studies suggested improved survival after iron chelation therapy, but valid data are limited. The aim of this study was to assess the effect of iron chelation on overall survival and hematological improvement in lower-risk myelodysplastic syndrome patients in the European MDS registry. We compared chelated patients with a contemporary, non-chelated control group within the European MDS registry, that met the eligibility criteria for starting iron chelation. A Cox proportional hazards model was used to assess overall survival, treating receipt of chelation as a time-varying variable. Additionally, chelated and non-chelated patients were compared using a propensity-score matched model. Of 2200 patients, 224 received iron chelation. The hazard ratio and 95% confidence interval for overall survival for chelated patients, adjusted for age, sex, comorbidity, performance status, cumulative red blood cell transfusions, IPSS-R, and presence of ringed sideroblasts was 0.50 (0.34-0.74). The propensity-score analysis, matched for age, sex, country, red blood cell transfusion intensity, ferritin level, comorbidity, performance status, and IPSS-R and additionally corrected for cumulative red blood cell transfusions and presence of ringed sideroblasts, demonstrated a significantly improved overall survival for chelated patients with a hazard ratio of 0.42 (0.27-0.63) compared to non-chelated patients. Up to 39% of chelated patients reached an erythroid response. In conclusion, our results suggest that iron chelation may improve overall survival and hematopoiesis in transfused lower-risk myelodysplastic syndrome patients. This trial was registered at www.clinicaltrials.gov as #NCT00600860.

U2 - 10.3324/haematol.2018.212332

DO - 10.3324/haematol.2018.212332

M3 - Article

C2 - 31278207

SN - 0390-6078

VL - 105

SP - 640

EP - 651

JO - Haematologica-The hematology journal

JF - Haematologica-The hematology journal

IS - 3

ER -

Impact of treatment with iron chelation therapy in patients with lower-risk myelodysplastic syndromes participating in the European MDS registry

Abstract

Bibliographical note

Access to Document

Profiles

Alex Smith

Cite this