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Iron chelation therapy of transfusion-dependent β-thalassemia during pregnancy in the era of novel drugs: is deferasirox toxic?

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Abstract

The life expectancy of thalassemic patients has increased, and now approaches that of healthy individuals, thanks to improved treatment regimens. However, pregnancy in women with β-Thalassemia Μajor remains a challenging condition. Recent advances in managing this haemoglobinopathy offer the potential for safe pregnancies with favorable outcome. However, clinical data regarding the use of chelation therapy during pregnancy are limited, and it is unclear whether these agents impose any risk to the developing fetus. Successful pregnancies following unintentional treatment with deferoxamine or deferasirox have rarely been reported. Generally, chelators are not recommended during pregnancy. Regarding the new oral chelators, data on fetotoxicity are lacking. In the present study, we describe the evolution and successful outcome of nine pregnancies in six Greek thalassemic women who received deferasirox inadvertently during early pregnancy, and review the literature regarding fetal anomalies due to chelators. Use of chelation before embarking upon a non-programmed pregnancy remains a difficult and unresolved question. In our study, chelation treatment during pregnancy did not prevent the delivery of healthy children. Nonetheless, the use of deferasirox is contraindicated in pregnant women, based on the product label. Deferasirox should only be used during pregnancy if the potential benefit outweighs the potential fetal risk.

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Acknowledgments

This study was conducted under the Declaration of Helsinki.

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    Authors and Affiliations

    1. Thalassemia Unit, General Hospital of Larissa, Tsakalov St. 1, 41221, Larissa, Greece

      Michael D. Diamantidis, Achilles Manafas & Paraskevi Fotiou

    2. Thalassemia Unit, Department of Haematology, Second Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki (AUTH), Konstantinoupoleos St. 49, 54 642, Thessaloniki, Greece

      Nikolaos Neokleous, Aleka Agapidou, Evaggelia Vetsiou & Efthymia Vlachaki

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    1. Michael D. Diamantidis
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    2. Nikolaos Neokleous
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    4. Evaggelia Vetsiou
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    Correspondence to Michael D. Diamantidis or Efthymia Vlachaki.

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    M. D. Diamantidis, N. Neokleous and A. Agapidou contributed equally to the study.

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    Diamantidis, M.D., Neokleous, N., Agapidou, A. et al. Iron chelation therapy of transfusion-dependent β-thalassemia during pregnancy in the era of novel drugs: is deferasirox toxic?. Int J Hematol 103, 537–544 (2016). https://doi.org/10.1007/s12185-016-1945-y

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    • DOI: https://doi.org/10.1007/s12185-016-1945-y

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