DFP

DFP is effective at increasing iron excretion; however, its efficacy has been established chiefly in patients with hemoglobinopathies, with minimal data available in MDS.
The safety profile of DFP in MDS is unclear, and concerns about agranulocytosis in patients with pre-existing neutropenia remain.
In a study of 48 MDS patients receiving DFP, a 4% incidence of agranulocytosis was seen¹.
Neutrophil counts should be monitored weekly.
The occasional MDS patient may be unable to tolerate either DFX or DFO^*.
DFP target dose is 75mg/kg/day in 3 divided doses.
- Some patients may be able to escalate to 100mg/kg/day.
Common side effects of DFP are GI & arthralgias.
- Patients should be initiated on 1/5-1/4 the target dose and the dose increased gradually as tolerated.

ELT

ELT shows strong ICT activity in pre-clinical models, as a single agent or in combination with other chelators^2-4.
***There are no clinical studies examining the ICT activity of ELT in MDS; therefore, no recommendations are made***
A recent study suggests that ELT supports the growth and replication of hematopoietic stem cells via ICT activity⁵.
A recent study indicates ELT may induce hematologic responses (all lineages) in up to 1/2 of patients with low-int-2 IPSS MDS⁶.

Eltrombopag at low concentration in combination with other chelators offloads iron & decreases ROS production in cardiac & hepatocyte cell lines⁷.