Iron overload and myelodysplastic syndromes.

Transfusion of RBC units, the only current treatment for many myelodysplast ic syndromes, and excess intestinal absorption of Fe related to dyserythopo iesis often result in iron overload. This condition is associated with high rates of morbidity and mortality. High-risk patients include those with re fractory anemia, sideroblastic anemia, 5q- syndrome, patients with a good p rognosis (low or lower intermediate international prognosis score), patient s having received over 100 RBC units, and patients under the age of 70. Def eroxamine, while it can prevent iron overload, is a strenuous treatment req uiring 8-to-12 hour- overnight subcutaneous injections. When patients compl y with the regimen, it efficiently prevents mortality due to iron overload, but must be implemented early in the disorder, usually before transfusing 20 RBC concentrates. A simple way of monitoring iron overload is to measure seric ferritin levels and record the number of RBC concentrates. The chela ting treatment should be modulated according to age, MDS type, internationa l prognosis score, number of RBC units received, ferritin levels, and most of all, patient tolerance. The direct subcutaneous approach is currently be ing evaluated by the French Group for Myelodysplasias for its efficiency to prevent disorders, but seems to be both efficient and well compiled with ( a national protocol is under way). The recent findings on the proteins impl ied in iron recycling by macrophages after destruction of RBCs, may in the long term, enable us to manage patients with less burdensome treatments and more effective new oral chelates. (C) 2001 Editions scientifiques et medic ales Elsevier SAS.