When and in whom should iron chelation therapy be initiated?

• IOL should prompt consideration of starting ICT to prevent iron-induced cellular damage, to preserve organ function & avoid excess morbidity & mortality.
• ICT should start before cellular & organ damage occurs.
  • The rate of iron loading varies widely among MDS patients.
  • Comorbidities, performance status, expected OS & planned therapies should all be considered.
  • The decision to begin ICT must be tailored to individual patient needs.
• Despite recommendations from guidelines, one study found that only 41% of lower risk MDS patients with IOL received ICT & that ICT was started at double the level of IOL recommended by guidelines; the reasons for this are unclear¹.