Combined use of oral chelators and desferrioxamine in thalassemia

The standard iron chelation therapy is based on the use of deferoxamine (DFO) [1]. A subcutaneous infusion of 20 /50 mg/kg/day over 8 /12 hours 6 / 7 days a week promotes a total iron excretion of 0.15 /0.5 mg/kg/day [2]. This may counterbalance the mean iron input from standard transfusional regimens of 0.25 /0.5 mg/kg/day [3]. The effectiveness of this treatment is mainly determined by the compliance, that may vary significantly [4]. During these last few years the oral chelator deferiprone (DFP) has been approved in many countries and gained room at least as a second line option for patients where DFO is not tolerated or inadequate [5,6]. The relative lower efficacy is partially counterbalanced by the advantages in compliance due to the administration route. Recent results from independent studies suggest that deferiprone may be more cardio protective than deferoxamine. Patients on long-term treatment with deferiprone have a better myocardial MRI pattern [7], and less chance to develop a new cardiac disease or to worsen an existing one [8].