How to treat iron overload in MDS, DFO
- The literature provides no evidence-based studies of high quality to guide the best approach to treating MDS patients with IOL. Three ICT agents are available: deferoxamine (DFO), deferasirox (DFX), and deferiprone (DFP); additionally, eltrombopag (ELT) has ICT activity. DFO & DFX are Health Canada approved for use in MDS. Patients becoming transfusion independent with other MDS treatments may undergo phlebotomy.
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Until recently, most clinical experience was with DFO.
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Because of its short half-life, DFO 20–50 mg/kg/day is given by 12-24 h SC continuous infusion for 5-7 days/week, though for compliance reasons, SC boluses or alternate routes of administration can be considered
1-5 . - Longer acting formulations of DFO are being developed and may have clinical application in future6.
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DFO should not be used in severe renal failure7.
Dosing: Renal Impairment: Adult
Severe renal disease or anuria: Use is contraindicated in the manufacturer's US labeling.The following adjustments have been used by some clinicians (Aronoff 2007): Adults:
- CrCl >50mL/minute: No adjustments required
- CrCl 10 to 50mL/minute, CRRT: Administer 25% to 50% of normal dose
- CrCl <10mL/minute, hemodialysis, peritoneal diaysis: Avoid use
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Because of its short half-life, DFO 20–50 mg/kg/day is given by 12-24 h SC continuous infusion for 5-7 days/week, though for compliance reasons, SC boluses or alternate routes of administration can be considered