Iron chelation therapy (ICT) with a combination of deferasirox (DFX) and deferoxamine (DFO) may improve bone mass in patients with transfusion-dependent beta thalassemia (TDT) while lowering serum ferritin levels, according to research reported in Expert Review of Hematology.

In this retrospective study, 256 patients with TDT who had received 1 of 5 ICT strategies were enrolled. ICT strategies included treatment with DFX, DFO, deferiprone (DFP), DFO with DFP, and DFX with DFO. Outcomes that were examined included serum ferritin level and bone mineral density (BMD), both of which were measured before and after treatment with dual-energy x-ray absorptiometry at a 12-month follow-up.

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Overall, there were no significant differences in serum ferritin or BMD changes between groups based on ICT strategy, but some improvements were seen.

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The greatest reduction in serum ferritin levels was seen with DFX plus DFO, with 41.5% of patients on this combination showing a 30% improvement in serum ferritin. DFX alone delivered a 30% improvement in serum ferritin to 30% of patients receiving this regimen.

In within-group assessments of patients, the broadest improvements in BMD were seen with the combination of DFX and DFO, suggesting this may be a promising regimen for targeting both BMD and serum ferritin levels.

Significant lumbar spine BMD improvements occurred within patients over time with DFX (P =.001) and DFX plus DFO (P =.025). Improvements with DFX plus DFO were also significant for both femoral neck (P =.02) and lumbar spine (P =.015) BMD Z-score changes.

“In conclusion, combination therapy [with] DFX and DFO might serve as the best ICT regimen for reducing bone loss in patients with TDT,” wrote the investigators. They indicated that further research over a longer duration should be performed in order to evaluate BMD outcomes with various ICT regimens.


  1. Bordbar M, Haghpanah S, Zekavat OR, Saki F, Bazrafshan A, Bozorgi H. Effect of different iron chelation regimens on bone mass in transfusion-dependent thalassemia patients. Expert Rev Hematol. 2019;12:997-1003