Dr. Steensma Discusses Iron Chelation Therapy for MDS

David P. Steensma, MD, attending physician, hematologic oncology, Dana-Farber Cancer Institute, Boston, MA, discusses the arguments against the use of iron chelation in patients with myelodysplastic syndrome (MDS).

One of the reasons some hematologic oncologists do not use chelation is because the 2 largest prospective studies that investigated it in MDS patients experienced dropout rates close to 50%. This high of a dropout rate is unusual, and was related to adverse events, disease progression, and unrelated deaths.

Steensma notes that despite the avid promotion of using iron chelation for MDS patients there is currently no prospective data showing morbidity or mortality benefits. An ongoing prospective trial, labeled TELESTO, plans to investigate the event free survival of MDS patients when treated with iron chelation; however, due to the strong opinions of physicians the trial has had a difficult time recruiting participants. Some retrospective studies support the use of iron chelation but Steensma explains that retrospective studies are inherently biased because the cause of a decision may have been due to an unrelated factor.

There is generally a low occurrence of side effects to chelation treatment when it is given correctly. The most common adverse events are diarrhea and an upset stomach, or more seriously, kidney failure. The overall safety and efficacy of iron chelation for patients with MDS remains greatly unknown. Without further prospective data it is difficult to address the concerns regarding the true risk and benefit balance of this treatment.