Blood Adv: changes in pancreatic iron levels in patients with thalassemia major and their association with iron chelator therapy

Pancreatic iron deposits are very common in thalassemia major(TM) and are detected
in more than one-third of patients with their first T2* magnetic resonance imaging (MRI) scan.
A study published in the journal Blood Advances prospectively evaluated changes in pancreatic iron levels in TM patients, reflecting their dependence on systemic iron balance by serum ferritin and liver iron levels, and their correlation
with different iron chelators in monotherapy.

The study included 295 patients with TM (37.
12±10.
68 years; 150 women), patients met the following criteria: 1) perform baseline and follow-up MRI after 18±3 months; 2) Maintenance of deferasirox or deferiprone or deferoxamine monotherapy between MRI scans
.
Three groups of patients were identified: 50 received deferoxamine, 65 received deferiprone and 180 received deferasirox
.

Pancreatic iron overload (whole pancreas T2* < 26 ms)
was detected in 251 patients (85.
1%).

MRI LIC values were significantly lower at the outset (2.
25±1.
32 mg/g dw vs 5.
94±8.
77 mg/g dw compared with patients with pathological pancreatic T2* on both scans; p = 0.
005）
。 In addition, 76.
9% of patients with improved baseline MRI LIC were normal (< 3 mg/g dw).

Of the 44 (14.
9%) patients without pancreatic iron overload at baseline, 13 (29.
5%) showed pancreatic iron overload
on follow-up MRI.
Of these patients, 8 had normal
MRI LIC values on both scans.
No differences
in baseline MRI LIC values or changes in MRI LIC values were detected between patients with worsening pancreatic T2* values and maintenance of normologies.

A significant negative correlation between whole pancreatic T2* and baseline whole pancreas' T2* values was detected (R = -0.
246; p < 0.
0001).

Changes in whole pancreatic T2* were not associated with baseline serum ferritin levels or MRI LIC values, but were negatively correlated
with changes in serum ferritin levels (R = -0.
224; p = 0.
001) and changes in MRI LIC values (R = -0.
226; p < 0.
0001).

In patients with pancreatic iron overload at baseline, pancreatic T2* values increased
significantly in all three groups of patients receiving iron chelator monotherapy (deferoxamine or deferiprone or deferasirox).
The reduction in pancreatic iron levels was comparable
between the three groups.
Research data show that iron removal from the pancreas is difficult, and that the three iron chelators in monotherapy have considerable efficacy
.

In summary, the three iron chelators in monotherapy were comparable
in reducing pancreatic iron.
Further randomised controlled trials are needed to confirm this result and explore the effects of
different iron chelation regimens.

Original source:

Antonella Meloni, Laura Pistoia, et al, Prospective changes of pancreatic iron in patients with thalassemia major and association with chelation therapy, Blood Advances, 2022, https://doi.
org/10.
1182/bloodadvances.
2022008805.