Reversal of cardiac complications in thalassemia major by long‐term intermittent daily intensive iron chelation

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Abstract
Objectives: In patients with thalassemia major (TM) who are non‐compliant with long‐term deferoxamine (DFO) chelation, survival is limited mainly because of cardiac complications of transfusional siderosis. It was recently shown in a small group of TM patients with established cardiac damage that continuous 24‐h DFO infusion via an indwelling intravenous (i.v.) catheter is effective in reversing cardiac toxicity. The aim of the present study was to evaluate the results with intermittent daily (8–10 h) i.v. DFO.Patients: Eight TM patients with cardiac complications treated with intensive intermittent DFO were retrospectively evaluated by the mean annual serum ferritin, radionucleated ventriculography and 24‐h electrocardiography recordings.Results: The median age at diagnosis of cardiac disease was 17.5 yr (range 14–21), and the median follow‐up time was 84 months (range, 36–120). In the majority of patients (seven of eight) high‐dose DFO (mean 95 ± 18.3 mg/kg/d) was administered via a central venous line. During follow‐up, there was a significant decrease in the mean ferritin levels (5828 ± 2016 ng/mL to 1585 ± 1849 ng/mL, P < 0.001). Both cardiac failure (mean ejection fraction 32 ± 5) and cardiac arrhythmias were resolved in four of five patients. One non‐compliant patient died during the follow‐up. Following discontinuation of the i.v. therapy, compliance with conventional DFO therapy improved. The complications of this regimen, mainly catheter‐related infections and catheter‐related thrombosis, were similar to those described earlier.Conclusions: These results with the longest follow‐up period in the literature suggest that i.v. high‐dose DFO for 8–10 h daily may be as effective as continuous 24‐h infusion for the reversal of established cardiac disease in TM.