Iron overload and iron chelation therapy in patients with myelodysplastic syndrome treated by allogeneic stem-cell transplantation: report from the working conference on iron chelation of the Gruppo Italiano Trapianto di Midollo Osseo

Many myelodysplastic syndrome (MDS) patients have a long history of transfusion before eventually undergoing transplantation and therefore are at high risk of developing parenchymal iron overload. Recently, retrospective studies suggested that iron overload has some prognostic impact in MDS patients treated by allogeneic stem-cell transplantation (allo-SCT) as previously observed in thalassemia. However, the optimal strategy to assess iron overload and to reduce iron burden during and after transplant procedure remains to be determined. The Gruppo Italiano Trapianto di Midollo Osseo (GITMO) promoted a consensus process aimed at providing clinical practice recommendations that can support the appropriate choice for iron overload assessment and for iron chelation therapy in MDS patients undergoing allo-SCT. A systematic review of the published literature (1990–2010) was performed. An Expert Panel was selected according to the framework elements of the NIH Consensus Development Program, comprising 10 physicians with different areas of expertise (iron metabolism, SCT, and MDS patient management/treatment). Based on the available scientific evidence and consensus among experts, clinical recommendations were formulated on appropriate assessment of iron body stores, selection of candidates to iron chelation therapy before and after allo-SCT, and treatment modalities.