Identification of patients likely to benefit from iron chelation therapy

• In BTM, an OS benefit is usually associated with ≥10 years of ICT.
  • The majority of newly diagnosed MDS patients are >70 years old, making it unclear whether they will survive long enough to develop significant enough organ iron deposition to benefit from ICT.
  • On the other hand, older MDS patients may be more prone to organ damage from IOL due to reduced physiologic reserve.
• LIC reduction in MDS has been documented as have decreases in elevated transaminases with ICT¹. info Evidence indicating ICT may influence hematopoiesis & AML transformation suggest that benefits info of ICT may occur earlier in MDS^2,3. info
• For TD MDS patients with expected survival <1-2 years (IPSS: ≥1.5, IPSS-R >4.5) most guidelines suggest it is unlikely that ICT will have a significant impact on morbidity or mortality. The exception may be HR patients with IOL eligible for SCT. In addition, some TD individuals with unfavourable prognostic scores but indolent disease behavior (with or without disease modifying therapy) may also benefit.