Combined chelation therapy with deferasirox and deferoxamine in thalassemia

Iron overload is the primary cause of mortality and morbidity in thalassemia major despite advances in chelation therapy. We performed a pilot clinical trial to evaluate the safety and efficacy of combined therapy with deferasirox (DFX, 20–30 mg/kg daily) and deferoxamine (DFO, 35–50 mg/kg on 3–7 days/week) in 22 patients with persistent iron overload or organ damage. In the 18 subjects completing 12 months of therapy, median liver iron concentration decreased by 31% from 17.4 mg/g (range 3.9–38.2 mg/g) to 12.0 mg/g (range 0.96–26.7 mg/g, p < 0.001). Median ferritin decreased by 24% from 2465 ng/mL (range 1110–10,700 ng/mL) to 1875 ng/mL (range 421–5800 ng/mL, p = 0.002). All 6 subjects with elevated myocardial iron showed improvement in MRI T2* (p = 0.031). The mean ± S.E. plasma non-transferrin-bound iron (NTBI) declined from 3.10 ± 0.25 μM to 2.15 ± 0.29 μM (p = 0.028). The administration of DFX during infusion of DFO further lowered NTBI (− 0.28 ± 0.08 μM, p = 0.004) and labile plasma iron (LPI, − 0.03 ± 0.01 μM, p = 0.006). The simultaneous administration of DFO and DFX rapidly reduced systemic and myocardial iron, and provided an excellent control of the toxic labile plasma iron species without an increase in toxicity. This trial was registered at www.clinicaltrials.gov as NCT00901199.