Combined Deferoxamine - Deferasirox in Treatment of Thalassemia Major with Iron Overload

Abstract

Background Iron overload is a major problem to thalassemia major patients. For the treatment of those patients, there is an important role played by the effective and  safe  iron  chelating  protocol  with  high  compliance  rate.  This  prospective comparative  study  was  conducted  for  the  assessment  of  the  deference  in  the response  of  serum  ferritin  and  safety  of  combined  Deferasirox  (DFX)  - Deferoxamine  (DFO)  therapy  and  deferasirox  (DFX)  protocol  in  a  group  of transfusion-dependent  thalassemia  major  patients  in  Najaf  thalassemia  center, Iraq. 
Material and Method  Forty two patients were studied, aged between 2 to 30 years old, mean SD (8±3). Patients divided in to two groups, 29 patients chosen randomly  on  DFX  (40  mg/kg/day),  and  13  patients  were  willing  to  continue combined therapy of DFO(20mg/kg/day infusion ,two days /week) and DFX.The duration  of  study  was  one  year.  Efficacy  of  both  regimes  determined  by assessment of serum ferritin level before and after treatment in both group, and the safety assessed by frequent monitoring of liver enzymes , blood urea and serum creatinine.                                                                               
Results After one year of therapy, patients on DFX alone have shown significant reduction of serum ferritin from mean (4482±452) range (1148-10450 ng/l), to mean of serum ferritin (3132±336) range (595-8743 ng/l) No significant changes were  observed  in  this  study  regarding  blood  urea  and  liver  enzymes,  but fortunately there was a decline in (ALT), from mean value of (82±16), to mean value (56±6).