Managing Iron Overload After Transplant in MDS

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Managing iron overload may not be the highest priority after stem cell transplantation in individuals with myelodysplastic syndromes (MDS), says Thomas Prebet, MD, PhD. Although iron overload can have long-term effects, such as fatigue, cardiac toxicities, and liver toxicities, these take time to develop, therefore, iron overload is never an emergency, says Prebet.

It is more important to focus on the more pressing matters after transplant, including the prevention or treatment of graft versus host disease, as well as infection. Addressing these more emergent concerns may lead to a delay in initiating iron chelation therapy. A few months after transplant, different chelation options can be considered, such as phlebotomy and the oral chelation agents.

Another reason for delay in iron chelation therapy is the potential side effects caused by iron chelation agents, which could complicate recovery. Side effects with deferasirox may include gastrointestinal toxicity, diarrhea, and some renal side effects, which are contraindicated for patients on cyclosporine treatment. Additionally, deferoxamine, the other chelation agent, may cause platelet toxicity.