Iron chelation therapy may reduce mortality and leukemia transformation risk among patients with myelodysplastic syndrome (MDS), according to a meta-analysis published in Clinical and Experimental Medicine.

Anemia is a common issue among patients with MDS. Red blood cell transfusion can be used to treat anemia in these patients but can also lead to iron overload, which is exacerbated by unrestrained intestinal iron uptake. Iron chelation therapy is sometimes administered to patients with MDS when iron overload occurs, but there is debate as to whether this is a sufficiently safe and effective treatment.

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In a systematic review and meta-analysis, researchers evaluated data from 14 prospective or retrospective studies to evaluate associations between iron chelation therapy and overall survival (OS) and leukemia-free survival (LFS).

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Overall, patients who received iron chelation therapy experienced improved OS (hazard ratio [HR], 0.57; P <.001) and LFS (HR, 0.70; P =.016). These results, however, were not consistent among the studies evaluated, with the highest-weighted study in the OS analysis showing an HR of only 0.99. The researchers noted that the only randomized clinical trial included reported an HR for OS with iron chelation therapy of 0.832.

A subgroup analysis found that although iron chelation therapy conferred improvement in OS to patients with any risk score using the International Prognostic Scoring System (HR, 0.57; P <.001), patients with low or intermediate-1 international prognostic scoring system scores saw a greater benefit (HR, 0.48; P <.001). The role of serum ferritin levels in clinical decision making in these cases is currently unclear.

“More well-designed randomized clinical trials are expected to confirm the current results and further seek measures to reduce treatment-related adverse reactions and explore the threshold of serum ferritin for initiating iron chelation therapy,” wrote the researchers.


1.     Liu H, Yang N, Meng S, Zhang Y, Zhang H, Zhang W. Iron chelation therapy for myelodysplastic syndrome: a systematic review and meta-analysis [published online November 11, 2019]. Clin Exp Med. doi:10.1007/s10238-019-00592-5