Pathophysiological and Clinical Aspects of Iron Chelation Therapy in MDS

The majority of patients with myelodysplastic syndromes (MDS) become transfusion-dependent during the course of disease and may thus develop transfusional iron overload. As a further contributor to iron overload there is increased absorption of dietary iron from the gut, as a consequence of ineffective erythropoiesis. Compared with thalassemia, it is less clear how frequent patients with MDS develop clinical complications of iron overload, and whether the accumulation of iron shortens their survival. This review aims to summarize our current knowledge of the detrimental effects of transfusional iron overload in MDS, point out the risks associated with ironinduced oxidative stress, describe the tools available for diagnosing iron overload, indicate the treatment options with currently available iron chelators, and discuss the measurement of labile plasma iron (LPI) as a tool to monitor the efficacy of iron chelation therapy.