INTRAVENOUS CHELATION-THERAPY DURING TRANSPLANTATION FOR THALASSEMIA

Background. Thalassemia patients with heavy iron overload risk further increase of body iron stores after bone marrow transplantation (BMT) due to intensive red-cell transfusions in the post BMT course and to m assive mobilization of iron deposits from marrow cells following the c onditioning regimen. Nevertheless, iron chelation has not yet been use d during the transplant period, mainly for concerns related to the tox icity and antiproliferative properties of the drug. Methods. Fifteen t halassemic patients received desferrioxamine (DFO) before and during B MT according to two different schedules (first: from day -9 to day +60 , and second: from day -9 to day -2, then from day +28 to day +60) at a dose of 40 mg/kg/day as a 24-hour intravenous infusion. Results. The median time to neutrophil, platelet and erythrocyte recovery showed n o difference between DFO-treated patients and the control group (18 da ys vs. 15, 16 vs. 18 and 22 vs. 23, respectively; IF: NS.). The incide nce of acute GVHD was 23% in the DFO group and 13% in controls (p: N.S .). The median serum ferritin (SF) at 6 months after BMT was significa ntly lower in the DFO-treated patients (2081 versus 4187; p: 0.007) th an in the control group. This difference continued to be evident, thou gh not statistically significant, during longer follow-up. Conclusions . Intravenous DFO therapy during BMT does not seem to have affected th e engraftment parameters or the incidence of infections or GVHD. No ad verse effects were observed during the therapy. Therefore thalassemic patients with heavy iron overload can be candidates for a course of i. v. chelation during the transplant period. This therapy could also be followed by post-BMT iron removal (ie. phlebotomies or desferrioxamine ) to accelerate the clearance of body iron deposits.