Studies examining overall survival in transfusion dependent patients with lower IPSS risk MDS by receipt of iron chelation therapy.
Study N Design Endpoint Non-chelated
patients		 Chelated patients p value Reference
Leitch 2008 178 Retrospective Median OS 40 mo Not reached 0.003 [1]
4-year OS 43% 64% 0.003  
Rose 2010 97 Retrospective follow-up Median OS 53 mo 124 mo <0.0003 [2]
Median OS:
adequate vs weak ICT 		NA 124 vs 85 mo <0.001  
Neukirchen 2012 188 Matched pair analysis Median OS 49 mo 75 mo 0.002 [3]
Komrokji 2011 97 Retrospective Median OS 34 mo 59 mo 0.013 [4]
Delforge 2012 186 Retrospective Median OS 37 mo 126 mo <0.001 [5]
Zeidan 20151 3926 Retrospective, registry Median OS 47 wk 110 wk 0.003 [6]
HR for death,
14-26 wks on DFX 		1 0.77    
HR for death,
≥53 wks on DFX 		1 0.34 <0.001  
Remacha 2012, 2015 263 Retrospective Median OS 105 mo 133 mo <0.001 [7,8]
Leitch 2012 268 Retrospective Median OS, non-RARS
Median OS, RARS 		44 mo
73.8 mo 		NR
134.4 mo 		<0.001
0.025 		[9]
Lyons 20172 599 Retrospective, registry Median OS 47.8 mo All 86.3 mo
ICT >6 mo, 98.7 mo 		<0.0001 [10]
Langemeijer 20163 765 Prospective, registry Adjusted HR
(for superior OS)

TR
SF 		1 1.5
1.6 		0.006 [11]
Mainous 20144 1562 Meta-analysis Pooled OR
(for superior OS) 		1 1.984 <0.0001 [12]
Leitch 20175 239 Prospective, registry Median OS

MVA 		2.1 y

HR for death, 2.0 		52 y <0.001

0.03 		[13]
Hoeks 2019 788 Prospective, registry HR for death,
propensity matched analysis 		1 0.42
(0.27-0.63) 		NR [14]
Liu 2019 7242 Meta-analysis HR for death 1 0.57
(0.52-0.93) 		0.0016 [15]
Zeidan 2019 2450 Meta-analysis Adjusted HR for death 1 0.42
(0.28-0.62) 		<0.01 [16]
AML, acute myeloid leukemia; CM, comorbidities; CVS, cardiovascular; DFO, deferoxamine; DFX, deferasirox; HR, hazard ratio; ICT, iron chelation therapy; MDS, myelodysplastic syndromes; mo, months; MVA, multivariate analysis; n, number; NA, not applicable; NR, not reported; NS, not significant; OR, odds ratio; OS, overall survival; RARS, refractory anemia with ringed sideroblasts; RBC, red blood cell; RBCU, red blood cell units; SF, serum ferritin; TD, transfusion dependent; TR, transfusion requirements; wk, weeks; y, years. 1Patients receiving >20 RBCU. 2Similar results were seen in patients with & without concomitant CVS or endocrine CM. There were more MDS/AML deaths, infections, malignancies in non- ICT patients (p=0.0014). 3only significant for DFX as initial ICT, NS for DFO. 4metaanalysis of 11 studies. 5OS was measured from RBC TD. Four measures of clinical frailty, disability and CM were equivalent between groups. Several matched pair analyses were also significant for OS. Modified from Wells RA, et al. Leuk Res. 2008;32:1338-53 and Leitch HA, et al. Leuk Res. 2018;74:21-41.