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Efficacy and safety of iron chelator for transfusion-dependent patients with myelodysplastic syndrome: a meta-analysis
Zhang J, Shi P, Liu J, Li J, Cao Y
Hematology (Amsterdam, Netherlands). 2019;24(1):669-678
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Abstract
To systematically evaluate the efficacy and safety of iron chelators for transfusion-dependent patients with MDS. Thirteen cohort studies with 12,990 patients diagnosed with MDS were included in this study. According to m eta-analysis results transfusion-dependent MDS patients with secondary iron overload had a longer (HR = 0.52, 95%CI = 0.43-0.62, P < 0.001). Further subgroup analysis revealed a longer LFS (HR = 0.84, 95%CI = 0.76-0.93, P = 0.001) in MDS patients receiving iron chelators than in MDS patients not receiving iron chelators (HR = 0.52, 95%CI = 0.43-0.62, P < 0.001) and in patients with lower-risk MDS (HR = 0.50, 95%CI = 0.43-0.59, P < 0.001). Subgroup analysis of DFX showed that compared with patients not treated with iron chelators, the group receiving DFX monotherapy had significantly increased OS (HR = 0.43, 95%CI = 0.27-0.69, P < 0.001). In terms of tolerance, meta-analysis of binary variables in CAEs indicated that the occurrence of CAEs was significantly reduced by ICT (RR = 0.64, 95%CI = 0.57-0.71, P < 0.001).
PICO Summary
Population
Transfusion dependent patients with myelodysplastic syndrome (n=12,990, 13 studies).
Intervention
Iron chelator therapy (n=1999).
Comparison
No iron chelator therapy (n=10991).
Outcome
Patients with secondary iron overload had a longer overall survival. Further subgroup analysis revealed a longer leukaemia free survival (LFS) in MDS patients receiving iron chelators than in MDS patients not receiving iron chelators and in patients with lower-risk MDS. Subgroup analysis of Deferasirox (DFX) showed that compared with patients not treated with iron chelators, the group receiving DFX monotherapy had significantly increased overall survival. The occurrence of cardiac adverse eventss was significantly reduced by iron chelator therapy.