The oral iron chelator deferasirox might improve survival in allogeneic hematopoietic cell transplant (alloHSCT) recipients with transfusional iron overload Serdar Sivgin a,⇑ , Suleyman Baldane b , Gulsah Akyol a , Muzaffer Keklik a , Leylagül Kaynar a , Fatih Kurnaz a , Cigdem Pala a , Gokmen Zararsiz c , Mustafa Cetin a , Bulent Eser a , Ali Unal a a Dedeman Stem Cell Transplantation Hospital, Department of Hematology, Faculty of Medicine, Erciyes University, Kayseri, Turkey b Department of Internal Medicine, Faculty of Medicine, Erciyes University, Kayseri, Turkey c Department of Biostatistics, Faculty of Medicine, Erciyes University, Kayseri, Turkey article info Article history: Received 24 December 2012 Accepted 3 July 2013 Keywords: Allogeneic haematopoietic stem cell transplantation Deferasirox Iron overload Survival abstract Introduction: Iron overload (IO) has been shown to be an important cause of mortality and morbidity in patients who underwent allogeneic hematopoietic stem cell transplantation (alloHSCT). This study aimed to evaluate the possible effect of oral iron-chelation treat- ment (deferasirox) on survival in alloHSCT recipients in the posttransplant period. Materials and methods: A total of 80 alloHSCT recipients with IO were analyzed, retrospec- tively. Pretransplant and posttransplant data were obtained from the patients’ files. Patients were divided into two groups. Group 1; patients who did not receive any chelator treatment due to side effects or compliance problems. These patients were treated by phle- botomy. Group 2 consisted of patients who received deferasirox treatment. Results: The median treatment duration with deferasirox was 122 days (min–max:91– 225). The iron chelating treatment significantly reduced serum ferritin levels administered at a dosage of 20–30 mg/kg/day (p < 0.001). The median OS in Group 1 was found 16.0 (min–max:1.0–63.0) months and 25.0 (min–max:3.0–72.0) months in Group 2. In univar- iate and multivariate analysis, patients in Group 1 showed poorer OS compared to those in Group 2 with an increase in risk of death (HR:3.22, min–max:1.67–6.23, p = 0.001 and HR:3.51,, min–max:1.75–6.99, p < 0.001; respectively). The median DFS in Group 1 was found 11.0 (min–max:3.0–24.0) months and 22.0 (min–max:8.0–43.0) months in Group 2. The difference was found statistically significant (p = 0.023). The other factors that we found significant difference in multivariate analysis between groups were; presence of acute GVHD (patients with aGVHD had increased risk of death compared to patients with- out aGVHD (HR:2.49, min–max: 1.32–4.69, p = 0.005), chronic GVHD (HR:2.57, min– max:1.23–5.41, p = 0.013), median interval to tx (HR: 2.23, min–max:1.17–4.26, p = 0.015) and HLA match (HR:3.01, min–max:1.35–6.73, p = 0.007) Conclusion: Oral deferasirox (Exjade) treatment may improve survival in patients with iron overload who underwent alloHSCT. Ó 2013 Elsevier Ltd. All rights reserved. 1. Introduction Transfusional iron overload (IO) increases the risk of infections, veno-occlusive disease and hepatic dysfunction in the post transplant period. The current data established 1473-0502/$ - see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.transci.2013.07.004 ⇑ Corresponding author. Address: Department of Hematology, Faculty of Medicine, Erciyes University, Kayseri 38039, Turkey. Tel.: +90 3522076666; fax: +90 3524379348. E-mail address: serdarsvgn@gmail.com (S. Sivgin). Transfusion and Apheresis Science 49 (2013) 295–301 Contents lists available at SciVerse ScienceDirect Transfusion and Apheresis Science journal homepage: www.elsevier.com/locate/transci