The deferiprone and deferasirox combination is efficacious in iron overloaded patients with [beta]-thalassemia major: A prospective, single center, open-label study

• Published in: Pediatric blood & cancer Vol. 62; no. 9; p. 1592
• Main Authors: Totadri, Sidharth, Bansal, Deepak, Bhatia, Prateek, Attri, Savita V, Trehan, Amita, Marwaha, R K
• Format: Journal Article
• Language: English
• Published: Glenview Wiley Subscription Services, Inc 01-09-2015
• Subjects: Hematology; Oncology; Pediatrics
• ISSN: 1545-5009; 1545-5017
• DOI: 10.1002/pbc.25533

Background The high cost, coupled with the need for continuous infusion, renders Desferrioxamine (DFO), a non-feasible option for iron-chelation in a large majority of patients with [beta]-thalassemia major in developing countries. Monotherapy with deferiprone (DFP) or deferasirox (DFX) may not always attain optimal control, particularly in heavily iron-loaded patients. Combination of DFP and DFX is a potential alternative. Procedure A prospective, single-center, open-label, uncontrolled study was conducted to evaluate the safety and efficacy of the combination in patients with [beta]-thalassemia major. Patients who had received either DFP or DFX for >1 year and a serum ferritin >2,000µg/L were enrolled. Blood counts, liver/renal functions, and serum ferritin were monitored during the 1-year study period. Facilities for cardiac T2*-MRI were unavailable. Results Thirty-six patients with a mean age of 13 ± 6.9 years (range: 4-29) and a ferritin of 6,768 ± 4,145µg/L formed the study cohort. Eight (22%) patients had transient gastrointestinal adverse effects. DFX was discontinued in one patient for persistent abdominal pain/diarrhea. Eight (22%) had joint symptoms; DFP was discontinued in two. Four (11%) patients had elevation in AST/ALT levels, managed with temporary interruption of DFX. Nine (25%) had an inconsistent elevation of creatinine to >33% of baseline; no intervention was done. One had transient proteinuria. None had neutropenia. At the end of 1 year, the serum ferritin reduced by a mean value of 3,275.3 ± 618.2µg/L (P<0.001). Conclusions The oral combination was found to be safe, efficacious, and a feasible option in patients with suboptimal response to monotherapy. Pediatr Blood Cancer 2015;62:1592-1596. © 2015 Wiley Periodicals, Inc.