Iron overload toxicity is the main cause of mortality and morbidity in thalassaemia patients. The complete elimination and prevention of
iron overload is the main aim of
chelation therapy, which can be achieved by chelation protocols that can effectively remove excess
iron load and maintain body
iron at normal levels.
Deferiprone and selected combinations with
deferoxamine can be designed, adjusted and used effectively for removing all excess stored
iron and for maintaining normal
iron stores (NIS) in different categories of thalassaemia patients. High doses of
deferiprone (75-100 mg/kg/day) and
deferoxamine (50-60 mg/kg, 1-7 days/week) combinations can be used for achieving and maintaining NIS in heavily
iron loaded transfused patients. In contrast,
deferiprone (75-100 mg/kg/day) can be used effectively and sometimes intermittently for maintaining NIS in non heavily transfused patients.
Deferasirox can in particular be used in patients not tolerating
deferoxamine and
deferiprone. The design of tailored made personalised protocols using
deferiprone and selected combinations with
deferoxamine should be considered as optimum
chelation therapies for the complete treatment and the prevention of
iron overload in thalassaemia.