Alessia Pepe

Antonella Meloni

Antonino Vallone

Crocetta Argento

Daniele De Marchi

Mari Neri

Maria Resta

Massimiliano Missere

Silvia Macchi

Vincenzo Positano

Journal of Cardiovascular Magnetic Resonance

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POSTER PRESENTATION Open Access
MRI prospective survey on cardiac and hepatic
iron in transfusion-dependent thalassemia
intermedia patients treated with desferrioxamine,
deferiprone and deferasirox
Antonella Meloni1*, Mari Giovanna Neri1, Maria Chiara Resta2, Massimiliano Missere3, Antonino Vallone4,
Vincenzo Positano1, Silvia Macchi5, Crocetta Argento6, Daniele De Marchi1, Alessia Pepe1
From 18th Annual SCMR Scientific Sessions
Nice, France. 4-7 February 2015
Background
Few studies have evaluated the efficacy of iron chelation
therapy in thalassemia intermedia (TI) patients. Our
study aimed to prospectively assess by quantitative Mag-
netic Resonance imaging (MRI) the efficacy of the three
available chelators in monotherapy in transfusion depen-
dent (TD) TI patients.
Methods
Among the 325 TI patients enrolled in the MIOT (Myo-
cardial Iron Overload in Thalassemia) network, we
selected 103 TI patients TD with an MRI follow-up
(FU) study at 18±3 months who had been received one
chelator alone between the two MRI scans. Iron over-
load was assessed by the T2* multiecho technique.
Hepatic T2* values were converted into liver iron con-
centration (LIC) values.
Results
Three groups of patients were identified: 27 patients (13
females, mean age 40.12±10.31 years) treated with des-
ferioxamine (DFO - mean dosage 37.52±8.69 mg/kg/
die), 23 patients (14 females, mean age 34.73±10.67
years) treated with deferiprone (DFP- dosage 71.70
±14.46mg/kg/die) and 14 patients (9 females, mean age
36.63±10.92 years) treated with deferasirox (DFX -
mean dosage 27.75±5.04 mg/kg/die). Excellent/good
levels of compliance were similar in the DFO (92.6%),
DFP (100%) and DFX (100%) groups (P=0.345). The
mean starting age of regular transfusion was 14.73
±15.89 years.
At baseline in DFO group two patients (7.4%) showed
a global heart T2*<20 ms and one of them showed no
cardiac iron at the FU. At baseline in DFP group two
patients (8.7%) showed a global heart T2*<20 ms and
one of them showed no cardiac iron at the FU. All the 5
patients (35.7%) under DFX therapy with pathological
global heart T2* at the baseline remained at the same
status at the FU. The percentage of patients who main-
tained a normal global heart T2* value was comparable
for DFO (100%), DFP (100%) and DFX (88.9%) groups
(P=0.164).
Among the 46 patients with hepatic iron at baseline
(MRI LIC ≥3 mg/g/dw), the reduction in the MRI LIC
values was significant only in the DFO group (DFO:
-3.39±6.38 mg/g/dw P=0.041; DFP: -2.25±6.01 mg/g/dw
P=0.136 and DFX: -0.36±5.56 mg/g/dw P=0.875). The
decrease in MRI LIC values was comparable among the
groups (P=0.336). The number of patients with a MRI
LIC<3 mg/g/dw went up from 10 (37%) to 11 (40.7%) in
the DFO group, from 6 (26.1%) to 8 (34.8%) in the DFP
group and from 2 (14.3%) to 8 (57.1%) in the DFX
group. The percentage of patients who maintained a
normal MRI LIC value was comparable for DFO (90%)
vs DFP (50%) and DFX (100%) groups (P=0.191).
Conclusions
Prospectively in transfusion-dependent TI patients at the
dosages used in the clinical practice, DFO and DFP
showed 100% efficacy in maintaining a normal global1CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
Full list of author information is available at the end of the article
Meloni et al. Journal of Cardiovascular Magnetic
Resonance 2015, 17(Suppl 1):P357
http://www.jcmr-online.com/content/17/S1/P357
© 2015 Meloni et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://
creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
heart T2* value while DFX had 100% efficacy in main-
taining a normal LIC value.
Further prospective studies involving more patients
with iron at the baseline are needed to establish which
is the most effective drug in reducing iron levels.
Funding
The MIOT project receives “no-profit support” from
industrial sponsorships (Chiesi Farmaceutici S.p.A. and
ApoPharma Inc.).
Authors’ details
1CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
2Struttura Complessa di Radiologia, OSP. SS. Annunziata ASL Taranto,
Taranto, Italy. 3Dipartimento di Radiologia, Un. Cattolica del Sacro Cuore -
Centro di Ricerca e Formazione ad Alta Tecnologia “G. Paolo II”,
Campobasso, Italy. 4Istituto di Radiologia, Az. Osp. “Garibaldi” Presidio
Ospedaliero Nesima, Catania, Italy. 5Servizio trasfusionale, Ospedale Santa
Maria delle Croci, Ravenna, Italy. 6Centro di Talasssemia, Ospedale San
Giovanni Di Dio, Agrigento, Italy.
Published: 3 February 2015
doi:10.1186/1532-429X-17-S1-P357
Cite this article as: Meloni et al.: MRI prospective survey on cardiac and
hepatic iron in transfusion-dependent thalassemia intermedia patients
treated with desferrioxamine, deferiprone and deferasirox. Journal of
Cardiovascular Magnetic Resonance 2015 17(Suppl 1):P357.
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Figure 1 Changes of global haert T2* (up) and MRI LIC values (bottom) in TD TI patients treated with different iron chelators in monotherapy
Meloni et al. Journal of Cardiovascular Magnetic
Resonance 2015, 17(Suppl 1):P357
http://www.jcmr-online.com/content/17/S1/P357
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MRI prospective survey on cardiac and hepatic iron in transfusion-dependent thalassemia intermedia patients treated with desferrioxamine, deferiprone and deferasirox

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MRI prospective survey on cardiac and hepatic iron in transfusion-dependent thalassemia intermedia patients treated with desferrioxamine, deferiprone and deferasirox

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