Studies examining an impact of reducing IOL around SCT for hematologic malignancies

Table. Studies examining an impact of reducing IOL around SCT for hematologic malignancies.
Time of intervention	Study type	SCT type	N	Disease type	IOL measure	Intervention	Endpoints	Reference
Pre-SCT	Retro	Allo NOS	101	Multiple	Pre SF	DFO	TRM, EFS, OS p≤0.001 for all	Lee 2009
Pre-SCT	Pro	MA	5	AML, MDS	SF >1000 LIC >5	DFO	Closed for slow accrual	Armand 2013
Post-SCT	Pro	Allo + ASCT	10		SF	Phleb	Improved LFT’s in most¹	McKay 1996
Post-SCT	Pro	Allo NOS	38	Multiple	SF LIC by MRI	Phleb (n=29)	10/16 normalized AST/ALT	Rose 2007
Post-SCT	Pro	Allo NOS	20	Multiple	SF >1000 LIC by MRI	Phleb	SF decreased (p=0.0001) LIC decreased (p=0.0003)	Kew 2015
Post-SCT	Pro	MA, NMA	23	Multiple	LIC by MRI	Phleb (n=8), ICT (n=3)	Phleb — liver disease (n=3), CHF (n=1), all improved ICT — all LIC improved Observation — 4 of 5 had decrease in SF over time	Majhail 2010
Post-SCT	Pro	MA, RIC	42	Multiple	SF>1000 LIC by SQUID	Phleb (n=19)	LIC improved (p<0.001) LFT improved (p≤0.027) IFI, p=0.006	Busca 2010
Post-SCT	NS	Allo NOS	6	Myeloid	LIC by biopsy; severe IOL in 4	EPO-assisted phleb	SF normal @ 11 mo LFT normal @ 7 mo 4 able to d/c IS for GVH	Kamble 2006
Post-SCT	Pro	Allo NOS	23	Multiple	SF liver bx	Phleb or DFO	Improved SF Improved LFT’s	Tomas 2000
Post-SCT	NS	Allo NOS	143	Multiple	SF >2000 no infection increased LFT LIC by MRI	DFO	MVA: DFO >2mo decreased RI (p=0.01) including in advanced disease (p=0.03) improved DFS (p=0.01)	Kaloyannidis 2010
Post-SCT	Pro	Allo NOS	76	AML, MDS²	SF >1000 CRP <10	DFX 10 mg/kg/d, adjusted; until SF <500 or EOS	SF decreased (p<0.0001) 7.5 mg/kg/d best-tolerated AE similar to non-SCT	Jaekel 2016
Post-SCT	Pro	Allo NOS	30	Multiple	≥6mo post SCT	DFX 10 mg/kg/d x52 wk or to normalized SF	AE as expected	Vallejo 2014
Post-SCT	Retro	MA, NMA	80	Multiple	SF post ≥1000	DFX vs phleb	MVA: OS favored DFX 0.023	Sivgin 2013
Post-SCT	Pro	Allo NOS	8	AL, AA	Engrafted, Hb <LLN, TD	DFX	Median time to TI 23d following start of DFX	Visani 2014
¹numbers not given ²predominantly. AA, aplastic anemia; AE, adverse events; AL, acute leukemia; Allo, allogeneic; ALT, alanine aminotransferase; AML, acute myeloid leukemia; ASCT, autologous stem cell transplantation; AST, aspartate aminotransferase; bx, biopsy; CHF, congestive heart failure; CRP, C-reactive protein; d, days; d/c, discontinue; DFO, deferoxamine; DFS, disease-free survival; DFX, deferasirox; EFS, event-free survival; EOS, end of study; EPO, erythropoietin; GVH, graft versus host; Hb, hemoglobin; ICT, iron chelation therapy; IFI, invasive fungal infection; IOL, iron overload; IS, immunosuppression; LIC, liver iron concentration; LFT’s, liver function tests; LLN, lower limit of normal; MA, myeloablative; MDS, myelodysplastic syndrome; mo, months; MRI, magnetic resonance imaging; NMA, non-myeloablative; MVA, multivariate analysis; n, number; NOS, not otherwise specified; NS, not specified; OS, overall survival; phleb, phlebotomy; pro, prospective; retro, retrospective; RI, relapse incidence; RIC, reduced intensity conditioning; SCT, stem cell transplantation, SF, serum ferritin; SQUID, Superconducting Quantum Interference Device; TD, transfusion dependent; TI, transfusion independent; TRM, transplant-related mortality; wk, weeks. Leitch HA, et al. Crit Rev Oncol Hematol. 2017;113:156-170.