Phlebotomy to Reduce Iron Overload in Patients Cured of Thalassemia by Bone Marrow Transplantation

In thalassemia after successful bone marrow transplantation tin decreased from 2,587 (2,129 to 4,817) to 417 (210 to 982) (BMT), iron overload remains an important cause of morbidmg/L (PÚ .0001), total transferrin increased from 2.34Ô 0.37 ity. After BMT, patients have normal erythropoiesis capable to 2.7Ô 0.58 g/L (P! .0001), transferrin saturation decreased of producing a hyperplastic response to phlebotomy so that from 90%Ô 14% to 50%Ô 29% (PÚ .0001). Liver iron concenthis procedure can be contemplated as a method of mobiliztration evaluated on liver biopsy specimens decreased from ing iron from overloaded tissues. A phlebotomy program (6 20.8 (15.5 to 28.1) to 4.2 (1.6 to 14.6) mg/g dry weight (P Ú mL/kg blood withdrawal at 14-day intervals) was proposed .0001). Aspartate transaminase decreased from 2.7 Ô 2 to to 48 patients with prolonged follow-up (range, 2 to 7 years) 1.1 Ô 0.6 (P Ú .0001) and alanine transaminase from 5.2 Ô after BMT. Seven patients were not submitted to the pro3.4 to 1.7Ô 1.2 (PÚ .0001) times the upper level of normality. gram (five because of refusal and two because of reversible The Knodell score for liver histological activity decreased side effects). The remaining 41 patients (mean age, 16 Ô 2.9 from 6.9 Ô 3 to 4.9 Ô 2.8 (P Ú .0001). These data indicate years) were treated for a mean period of 35 Ô 18 months. that phlebotomy is safe, efficient, and widely applicable to All were evaluated before and after 3 Ô 0.6 years of followex-thalassemics after BMT. up. Values are expressed as mean Ô standard deviation (SD) q 1997 by The American Society of Hematology. or as median with a range (25 to 75 percentile). Serum ferri-