Geographical variations in current clinical practice on transfusions and iron chelation therapy across various transfusion-dependent anaemias

Abstract

Background and objectives: Many patients with chronic anaemia require blood transfusions as part of their treatment regimen. As a result, iron overload will inevitably develop if not adequately managed by iron chelation therapy. There are many guidelines relating to transfusion and chelation practices for patients with transfusion-dependent anaemia; however, there is a lack of information on how treatment practices differ around the world. The objective of this manuscript is to highlight key features of current transfusion and chelation management, including similarities and differences across various anaemias and between geographical regions worldwide.

Materials and methods: Data collected at study entry to the multicentre Evaluation of Patients' Iron Chelation with Exjade (EPIC) study, which recruited 1,744 patients with a variety of transfusion-dependent anaemias across 23 countries from three geographic regions, were assessed. These analyses compared transfusion and chelation treatment prior to the start of study treatment, together with iron burden assessed at study entry by serum ferritin, liver iron concentration and labile plasma iron levels.

Results and conclusions: Data show that transfusion and iron chelation practices differ between anaemias and between geographical regions; this may be linked to availability and accessibility of transfusion and chelation therapy, patients' compliance, physicians' attitudes, costs and use of treatment guidelines. Approximately 60% of these transfusion-dependent patients were severely iron overloaded with a serum ferritin level over 2,500 ng/mL, indicating that the risks of iron burden may have been underestimated and current iron chelation therapy, if considered, may not have been adequate to control iron burden.

Figure 1

Mean proportion of lifetime on transfusion therapy* for patients enrolled in the EPIC study included in these analyses. *Determined by the number of years the subject had already received transfusion therapy divided by age at screening; regular or intermittent transfusions were not differentiated in the protocol. Data from Taiwan were excluded because of inadequate data recording as a result of patients being referred to investigator sites for enrolment in the study.

Figure 2

Prior chelation therapy of patients enrolled in the EPIC study included in these analyses. *One MDS patient in Europe was classified as receiving “other” chelation therapy.

Figure 3A

Mean proportion of lifetime on chelation therapy* for patients enrolled in the EPIC study included in these analyses. *Determined by the number of years the subject had already received chelation therapy divided by age at screening; regular or intermittent transfusions were not differentiated in the protocol.

Figure 3B

Percentage of lifetime on transfusion vs percentage of lifetime on chelation for thalassaemia major and thalassaemia intermedia. Data from Taiwan were excluded due to inadequate data recording as a result of patients being referred to investigator sites for enrolment in the study.

Figure 4

Serum ferritin levels at study entry of patients enrolled in the EPIC study included in these analyses. Dashed line represents a serum ferritin level threshold of 2,500 ng/mL.

Figure 5

Serum ferritin level categories at study entry of patients enrolled in the EPIC study included in these analyses.

Figure 6

LIC at study entry of a subset of patients enrolled in the EPIC study included in these analyses. Dashed line represents a LIC threshold of 7 mg Fe/g dw.

Figure 7

LPI levels in a subset of patients enrolled in the EPIC study included in these analyses. Dashed line represents a LPI level threshold of 0.4 μmol/L.