Abstract：OBJECTIVE: To study the effectiveness and safety of deferasirox (DFX) in the treatment of iron overload in children with β-thalassemia major. METHODS: Twenty-four β-thalassemia major children with iron overload who received regular blood transfusion were randomly enrolled. The serum feritin (SF) levels were measured in the patients after different doses of DFX treatment. The DFX treatment-related adverse events were observed. The values of cardiac MRI T2* and liver MRI T2* were compared between the patients receiving DFX treatment for 5 years and the patients treated with deferoxamine and deferiprone. RESULTS: The patients with iron overload did not respond to DFX at the initial dose of 20-30 mg/kg?d. However, the SF level decreased significantly after the dose of DFX increased to 30-40 mg/kg?d (U=58, P<0.01). Serum liver transaminase elevation was the most common adverse effect, followed by non-progressive elevation in serum creatinine level. The mean SF level was significantly lower (1748±481 ng/mL vs 3462±1744 ng/mL; P<0.05), in contrast, the liver MRI T2* value was significantly higher (8.5±2.9 ms vs 2.7±1.9 ms; P<0.01) in patients receiving DFX treatment for 5 years than in the controls. There were no significant differences in the cardiac MRI T2* value between the two groups. CONCLUSIONS: DFX can reduce SF levels in a dose-dependent manner in children with β-thalassemia major. It can significantly lower liver iron overload but not cardiac overload. Serum liver transaminase elevation and non-progressive elevation in serum creatinine level are major adverse effects in DFX treatment.
GAO Hong-Ying,LI Qi,CHEN Juan-Juan et al. Curative effects and safety of deferasirox in treatment of iron overload in children with β-thalassemia major[J]. CJCP, 2011, 13(7): 531-534.
［4］Au WY, Lam WW, Chu WW, Yuen HL, Ling AS, Li RC, et al. A cross-sectional magnetic resonance imaging assessment of organ specific hemosiderosis in 180 thalassemia major patients in Hong Kong［J］. Haematologica, 2008, 93(5):784-786.
［5］Anderson LJ, Holden S, Davis B, Prescott E, Charrier CC, Bunce NH, et al. Cardiovascular T2-star(T2*) magnetic resonance for the early diagnosis of myocardial iron overload［J］. Eur Heart J, 2001, 22(23): 2171-2179.
［6］Pennell DJ, Porter JB, Cappellini MD, Chan LL, El-Beshlawy A, Aydinok Y, et al. Continued improvement in myocardial T2* over two years of deferasirox therapy in β-thalassemia major patients with cardiac iron overload［J］. Haematologica, 2011, 96(1):48-54.
［7］Cappellini MD. Iron-chelating therapy with the new oral agent ICL670 (Exjade) ［J］.Best Pract Res Clin Haematol, 2005, 18(2):289-298.
［8］Cappellini MD, Porter J, El-Beshlawy A, Li CK, Seymour JF, Elalfy M, et al. Tailoring iron chelation by iron intake and serum ferritin: the prospective EPIC study of deferasirox in 1744 patients with transfusion-dependent anemias［J］. Haematologica, 2010, 95 (4):557-566.
［9］Borgna-Pignatti C, Rugolotto S, De Stefano P, Zhao H, Cappellini MD, Del Vecchio GC, et al. Survival and complications in patients with thalassemia major treated with transfusion and deferoxamine［J］. Haematologica, 2004, 89(10):1187-1193.
［10］Atiq M, Bana M, Ahmed US, Bano S, Yousuf M, Fadoo Z, et al.Cardiac disease in beta-thalassaemia major: is it reversible?［J］. Singapore Med J, 2006, 47(8):693-696.
