Iron overload in myelodysplastic syndromes: Evidence based guidelines from the Canadian consortium on MDS

• Published in: Leukemia research 2018-11, Vol.74, p.21-41
• Main Authors: Leitch, Heather A., Buckstein, Rena, Zhu, Nancy, Nevill, Thomas J., Yee, Karen W.L., Leber, Brian, Keating, Mary-Margaret, St. Hilaire, Eve, Kumar, Rajat, Delage, Robert, Geddes, Michelle, Storring, John M., Shamy, April, Elemary, Mohamed, Wells, Richard A.
• Format: Article
• Language: English
• Subjects: Canada; Clinical outcomes; Female; Humans; Iron chelation therapy; Iron overload; Iron Overload - diagnosis; Iron Overload - metabolism; Iron Overload - pathology; Iron Overload - therapy; Male; MDS; Multicenter Studies as Topic; Myelodysplastic syndromes; Myelodysplastic Syndromes - diagnosis; Myelodysplastic Syndromes - metabolism; Myelodysplastic Syndromes - pathology; Myelodysplastic Syndromes - therapy; Practice Guidelines as Topic
• ISSN: 0145-2126; 1873-5835
• DOI: 10.1016/j.leukres.2018.09.005

•In 2008 Canadian guidelines on management of iron overload (IOL) in MDS were published.•Canadian hematologists with an interest in MDS here update the IOL guidelines.•Evidence for toxicity of IOL and clinical benefit of iron reduction are reviewed.•Evidence levels and recommendation grading are provided for all clinical endpoints.•Clinical management of IOL; who, when, why and how to treat IOL in MDS are addressed. In 2008 the first evidence-based Canadian consensus guideline addressing the diagnosis, monitoring and management of transfusional iron overload in patients with myelodysplastic syndromes (MDS) was published. The Canadian Consortium on MDS, comprised of hematologists from across Canada with a clinical and academic interest in MDS, reconvened to update these guidelines. A literature search was updated in 2017; topics reviewed include mechanisms of iron overload induced cellular damage, evidence for clinical endpoints impacted by iron overload including organ dysfunction, infections, marrow failure, overall survival, acute myeloid leukemia progression, and endpoints around hematopoietic stem-cell transplant. Evidence for an impact of iron reduction on the same endpoints is discussed, guidelines are updated, and areas identified where evidence is suboptimal. The guidelines address common questions around the diagnosis, workup and management of iron overload in clinical practice, and take the approach of who, when, why and how to treat iron overload in MDS. Practical recommendations for treatment and monitoring are made. Evidence levels and grading of recommendations are provided for all clinical endpoints examined.