Safety, Tolerability, and Efficacy of Deferasirox in MDS

It has been widely shown that an appropriate chelating therapy in chronic anemias transfusion dependent can prevent the overstock of iron and can reduce the already existing overstock reducing, then, the co-morbidity and improving survival.

In particular, some authors have shown in MDS affected patients undergoing intensive chelating therapy with deferoxamine haematological recovery with a reduction of the need of transfusions.

With the present study, we plan to evaluate the safety and efficacy of a therapy with the new oral chelating Deferasirox in MDS patients with transfusional hemosiderosis.

This is an open label, single arm study on Deferasirox treatment in MDS patients with chronic transfusional hemosiderosis.

Patients will receive daily oral dosis of Deferasirox in order to eliminate the quantity of iron administered during transfusions and, if needed, to reduce the overload of already present iron.

After an screening phase in which patients are evaluated according to eligibility criteria, a one year treatment phase foresees monthly visits to evaluate safety and efficacy signs.

Inclusion criteria

• Patients, both males and females, with low and intermediate I risk (IPSS score) Myelodysplastic syndrome and transfusion-induced hemosiderosis.
• Age >=18 years
• Patients who never received chelation therapy or who received a therapy with Desferal after a day of wash out
• Medical history of at least 20 blood transfusions (equivalent to 100 ml/kg of red cells concentrate).
• Availability of data concerning blood transfusions during the 12 weeks before screening
• Serum ferritin >= 1000 µg/L at least twice (at least 2 week interval between the 2 analysis) during the year before the screening
• Life expectancy > 12 months
• Availability of at least 3 complete blood counts (before transfusions) during the 12 weeks before the screening

Exclusion criteria

• Diagnosis different from MDS (i.e. myelofibrosis)
• Severe renal impairment (creatinine clearance < 60 ml/min)
• ALT/AST > 500 U/L
• Active B and/or C hepatitis
• Patients treated during the past 4 weeks with experimental drugs for MDS (including thalidomide, azacitidine, arsenic trioxide). These patients become eligible after a "wash out" of at least 4 weeks
• Concomitant treatment with another iron-chelating agent