Urinary iron excretion in young thalassemic patients receiving combined chelation treatment with deferoxamine and deferiprone

Abstract

To assess and compare the individual effect of different chelation agents on urinary iron excretion (UIE), we asked every patient, receiving combined chelation treatment with deferiprone (DFP) and deferoxamine (DFO), to provide four 24-hours urine samples; 2 samples were collected during days when patient was receiving only DFP, whereas the other 2 were collected when both chelation agents were administrated. Thirty young patients (15 males and 15 females) with beta-thalassemia major and a mean age of 18.54+/-4.62 years participated in the study. Mean serum ferritin concentrations were calculated 1 year prior and 1 year after the urine collection. A significant reduction in ferritin (P=0.001) was shown in the whole patients' series. Combined administration of DFO and DFP resulted in a statistically significant higher UIE than DFP alone (P=0.0007). On an individual basis, DFO and DFP resulted in a median 2.3-fold increase in UIE compared to monotherapy with DFP, ranging from 0.28 to 7.34-fold. Despite this wide variability, combined chelation treatment with DFO and DFP seems to act additively in the majority of the patients, whereas in some patients the huge increase in UIE with DFO and DFP can only be attributed to a synergistic effect.