Elsevier

Blood Reviews

Volume 23, Supplement 1, December 2009, Pages S15-S19
Blood Reviews

Review
Impact of iron overload in myelodysplastic syndromes

https://doi.org/10.1016/S0268-960X(09)70005-0Get rights and content

Abstract

Anaemia is prevalent in patients with myelodysplastic syndromes (MDS), and most patients with MDS receive regular red blood cell transfusions, which can lead to iron overload. Some patients may already have iron overload before transfusions begin, as a result of ineffective erythropoiesis. Iron overload has been linked to hepatic, cardiac, and endocrine dysfunction, although its exact contribution to cardiac failure and other complications is difficult to determine due to the advanced age of MDS patients and the prevalence of comorbidities. In addition, in patients with lower-risk MDS, a high serum ferritin level has been associated with an increased risk of leukaemic evolution independent of other prognostic factors, possibly related in part to the accumulation of free iron radicals. Finally, iron overload has been associated with poorer outcome after allogeneic stem cell transplantation and possibly with increased risk of infection. Thus, iron overload may negatively influence survival in patients with MDS, especially those with lower-risk disease. Iron chelation therapy may be beneficial in these patients.

References (54)

  • M Cazzola et al.

    Natural history of idiopathic refractory sideroblastic anemia

    Blood

    (1988)
  • P Armand et al.

    Prognostic impact of elevated pretransplantation serum ferritin in patients undergoing myeloablative stem cell transplantation

    Blood

    (2007)
  • U Platzbecker et al.

    Red blood cell transfusion dependence and outcome after allogeneic peripheral blood stem cell transplantation in patients with de novo myelodysplastic syndrome (MDS)

    Biol Blood Marrow Transplant

    (2008)
  • M Dürken et al.

    Nontransferrin-bound iron in serum of patients receiving bone marrow transplants

    Free Radic Biol Med

    (1997)
  • L Caroline et al.

    Elevated serum iron, low unbound transferrin and candidiasis in acute leukemia

    Blood

    (1969)
  • L von Bonsdorff et al.

    Apotransferrin administration prevents growth of Staphylococcus epidermidis in serum of stem cell transplant patients by binding of free iron

    FEMS Immunol Med Microbiol

    (2003)
  • C Aul et al.

    Epidemiological features of myelodysplastic syndromes: results from regional cancer surveys and hospital-based statistics

    Int J Hematol

    (2001)
  • X Ma et al.

    Myelodysplastic syndromes: incidence and survival in the United States

    Cancer

    (2007)
  • L Malcovati et al.

    Erythroid activity, transfusion iron overload, and hepcidin levels in patient with myelodysplastic syndrome

    Blood

    (2008)
  • JB Porter

    Practical management of iron overload

    Br J Haematol

    (2001)
  • Kelaidi C, Stamatoullas A, Beyne-Rauzy O, et al. Myelodysplastic syndrome (MDS) in France: results of a one-week...
  • L Malcovati et al.

    Prognostic factors and life expectancy in myelodysplastic syndromes classified according to WHO criteria: a basis for clinical decision making

    J Clin Oncol

    (2005)
  • WY Au et al.

    A pilot MRI study of organ specific hemosiderosis and functional correlation in Chinese patients with myelodyplasia and aplastic anemia with raised ferritin levels

    Hematol Oncol

    (2008)
  • J Chacko et al.

    Myocardial iron loading by magnetic resonance imaging T2* in good prognostic myelodysplastic syndrome patients on long-term blood transfusions

    Br J Haematol

    (2007)
  • JP Lu et al.

    Selective iron deposition in pancreatic islet B cells of transfusional iron-overloaded autopsy cases

    Pathol Int

    (1994)
  • E Konen et al.

    No evidence for myocardial iron overload in multitransfused patients with myelodysplastic syndrome using cardiac magnetic resonance T2* technique

    Am J Hematol

    (2007)
  • AA Di Tucci et al.

    Myocardial iron overload assessment by T2* magnetic resonance imaging in adult transfusion dependent patients with acquired anemias

    Haematologica

    (2008)
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