Clinical lymphoma, myeloma & leukemia · 2025
Utilization Patterns and Outcomes From Iron Chelation Therapy in Elderly Patients With Myelodysplastic Syndromes: A Population Analysis.
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Strumilowska Aneta, Sparks Andrew, Zakai Neil, Adrianzen Herrera Diego
Аннотация
BACKGROUND: Iron overload from red blood cell (RBC) transfusions is a source of morbidity and mortality in myelodysplastic syndromes (MDS). Evidence supporting iron chelation therapy (ICT) is limited for elderly patients.
MATERIALS AND METHODS: We analyzed real-world ICT utilization and outcomes in the U.S. Surveillance, Epidemiology, and End Results (SEER)-Medicare population. Between 2007 and 2017, MDS patients ≥66 years with ≥2-year survival was identified. Documented iron overload and/or cumulative ≥20 RBC within ≤2 years defined ICT eligibility. Survival, acute myeloid leukemia (AML), and iron-related cardiac and hepatic complications were assessed using multivariable Cox hazards, propensity score matching, and cause-specific regression.
RESULTS: Of 2564 eligible patients with median age 81, 15.3% received ICT. Deferasirox, deferoxamine, and deferiprone were used in 51.7%, 47.8%, and 0.5%, respectively. Predictors of ICT use included ringed sideroblasts histology (OR = 1.9), RBC transfusion density (OR = 1.1 per unit/month), and therapy with erythropoietin stimulating agents (OR = 1.5), hypomethylating agents (OR = 1.31) or lenalidomide (OR = 2.6). Of 352 ICT-treated transfusion-dependent patients, 78.9% achieved hematologic response (≥50% unit/month reduction). Across models, ICT was associated with 47%-48% reduced risk of mortality, 43%-49% reduced risk of AML, and 23%-32% reduced risk of adverse cardiac outcomes, driven by lower risk of heart failure. No effect on hepatic complications was identified.
CONCLUSION: These results suggest that ICT is associated with fewer transfusions, improved survival, lower risk of AML, and less adverse cardiac outcomes in unselected elderly patients with MDS.
MATERIALS AND METHODS: We analyzed real-world ICT utilization and outcomes in the U.S. Surveillance, Epidemiology, and End Results (SEER)-Medicare population. Between 2007 and 2017, MDS patients ≥66 years with ≥2-year survival was identified. Documented iron overload and/or cumulative ≥20 RBC within ≤2 years defined ICT eligibility. Survival, acute myeloid leukemia (AML), and iron-related cardiac and hepatic complications were assessed using multivariable Cox hazards, propensity score matching, and cause-specific regression.
RESULTS: Of 2564 eligible patients with median age 81, 15.3% received ICT. Deferasirox, deferoxamine, and deferiprone were used in 51.7%, 47.8%, and 0.5%, respectively. Predictors of ICT use included ringed sideroblasts histology (OR = 1.9), RBC transfusion density (OR = 1.1 per unit/month), and therapy with erythropoietin stimulating agents (OR = 1.5), hypomethylating agents (OR = 1.31) or lenalidomide (OR = 2.6). Of 352 ICT-treated transfusion-dependent patients, 78.9% achieved hematologic response (≥50% unit/month reduction). Across models, ICT was associated with 47%-48% reduced risk of mortality, 43%-49% reduced risk of AML, and 23%-32% reduced risk of adverse cardiac outcomes, driven by lower risk of heart failure. No effect on hepatic complications was identified.
CONCLUSION: These results suggest that ICT is associated with fewer transfusions, improved survival, lower risk of AML, and less adverse cardiac outcomes in unselected elderly patients with MDS.