Service d'Onco-Hématologie, Hôpital Saint Vincent de Paul, Université Catholique de Lille, Lille, France.
Leuk Res. 2010 Jul;34(7):864-70. doi: 10.1016/j.leukres.2009.12.004. Epub 2010 Feb 2.
Iron chelation therapy (CT) improves survival in thalassemia major but its beneficial effects on survival in MDS patients remain uncertain.
We analyzed, by multivariate analysis, survival and causes of deaths in 97 low or intermediate 1 IPSS patients regularly transfused as outpatients, chelated or not, who were included during a month period and followed for 2.5 years.
44 (45%) of patients were not chelated and 53 (55%) received CT, mainly with deferoxamine, for at least 6 months (median duration of chelation 36 months, range 6-131+). During the follow-up period, 66 of the 97 patients died, including 51% and 73% of chelated and non-chelated patients, respectively. Median overall survival was 53 months and 124 months in non-chelated and in chelated patients (p<0.0003). Causes of death did not significantly differ between the two groups (p=0.51). In multivariate Cox analysis, adequate chelation was the strongest independent factor associated with better OS.
Iron chelation therapy appears to improve survival in heavily transfused lower risk MDS, but prospective randomized studies are required to confirm our findings, and to determine more precisely the mechanisms of this potential survival benefit.
铁螯合疗法（CT）可改善重型地中海贫血患者的生存，但对骨髓增生异常综合征（MDS）患者的生存获益仍不确定。
我们通过多变量分析，分析了 97 例低危或中危 1 国际预后评分系统（IPSS）的 MDS 患者的生存情况和死亡原因，这些患者定期作为门诊患者输血，无论是否接受铁螯合治疗，在一个月内纳入并随访 2.5 年。
44 例（45%）患者未接受铁螯合治疗，53 例（55%）患者接受了 CT，主要使用去铁胺，至少持续 6 个月（螯合治疗的中位持续时间为 36 个月，范围 6-131+）。在随访期间，97 例患者中有 66 例死亡，其中未接受铁螯合治疗和接受铁螯合治疗的患者分别占 51%和 73%。未接受铁螯合治疗和接受铁螯合治疗的患者的中位总生存期分别为 53 个月和 124 个月（p<0.0003）。两组患者的死亡原因无显著差异（p=0.51）。多变量 Cox 分析表明，充分的铁螯合是与更好的 OS 相关的最强独立因素。
铁螯合治疗似乎可改善大量输血的低危 MDS 患者的生存，但需要前瞻性随机研究来证实我们的发现，并更精确地确定这种潜在生存获益的机制。
