Management of iron overload in the Canadian hematology/oncology population: Implications for nursing practice
Abstract
Red blood cell (RBC) transfusions are vital for many patients with chronic anemias associated with oncologic/hematologic disorders. However, repeated transfusions over time can lead to iron overload, which, if left untreated, can increase the risk of further malignancy and end-organ damage.Â
Nurses and other health care professionals may not be aware of the significant implications of RBC transfusions and iron overload in patients with hematological/oncological disorders. This article was developed by a group of Canadian nurse practitioners and specialized oncology nurses to help improve health care professionals’ understanding of iron overload in oncology patients and its associated risks, as well as provide a practical guide for the management of patients receiving treatment for this potentially serious condition.Â
Key words: oncology, malignant hematology, iron overload, iron chelation therapy, nursing practiceÂ
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Ãlvarez, F., Fernández-Ruiz, M., & Aguado, J.M. (2013). [Iron and invasive fungal infection]. Revista Iberoamericana de Micologia, 30(4), 217–225.
Andrews, N.C. (1999). Disorders of iron metabolism. New England Journal of Medicine, 341(26), 1986–1995.
Anemia Institute for Research & Education, Thalassemia Foundation of Canada. (2009). Guidelines for the Clinical Care of Patients with Thalassemia in Canada. Available at http://www.thalassemia.ca/wp-content/uploads/Thalassemia-Guidelines_LR.pdf
Borgna-Pignatti, C., Rugolotto, S., De Stefano, P., Zhao, H., Cappellini, M.D., Del Vecchio, G.C., Romeo, M.A., … Cnaan A. (2004). Survival and complications in patients with thalassemia major treated with transfusion and deferoxamine. Haematologica, 89(10), 1187–1193.
Bring, P., Partovi, N., Ford, J.A., Yoshida, E.M. (2008). Iron overload disorders: Treatment options for patients refractory to or intolerant of phlebotomy. Pharmacotherapy, 28(3), 331–342.
Cappellini, M.D. (2005). Overcoming the challenge of patient compliance with iron chelation therapy. Semin Hematol, 42(2 Suppl 1), S19–21.
Carson, S.M., & Martin, M.B. (2014). Effective iron chelation practice for patients with β-thalassemia major. Clinical Journal of Oncology Nursing, 18(1), 102–111.
Eckes, E.J. (2011). Chelation therapy for iron overload: nursing practice implications. Journal of Infusion Nursing, 34(6), 374–380.
Fenaux, P., Mufti, G.J., Hellstrom-Lindberg, E., Santini, V., Finelli, C., Giagounidis, A., Schoch, R., … Silverman, L.R. (2009). Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: A randomised, open-label, phase III study. Lancet Oncology, 10(3), 223–232.
Gabutti, V., & Piga, A. (1996). Results of long-term iron-chelating therapy. Acta Haematologica, 95(1), 26 –36.
Gattermann, N. (2008). Overview of guidelines on iron chelation therapy in patients with myelodysplastic syndromes and transfusional iron overload. International Journal of Hematology, 88(1), 24–29.
Gattermann, N. (2009). The treatment of secondary hemochromatosis. Deutsches Ärzteblatt International, 106(30), 499–504.
Goldberg, S.L., Giardina, P.J., Chirnomas, D., Esposito, J., Paley, C., & Vichinsky, E. (2013). The palatability and tolerability of deferasirox taken with different beverages or foods. Pediatric Blood & Cancer, 60(9), 1507–1512.
Hoffbrand, A.V., Taher, A., & Cappellini, M.D. (2012). How I treat transfusional iron overload. Blood, 120(18), 3657–3669.
Ibrahim, A.S., Gebremariam, T., Luo, G., Fu, Y., French, S.W., Edwards, J.E. Jr., & Spellberg B. (2011). Combination therapy of murine mucormycosis or aspergillosis with iron chelation, polyenes, and echinocandins. Antimicrobial Agents & Chemotherapy, 55(4), 1768–1770.
Lee, J.W., Kang, H.J., Kim, E.K., Kim, H., Shin, H.Y., & Ahn, H.S. (2009). Effect of iron overload and iron-chelating therapy on allogeneic hematopoietic SCT in children. Bone Marrow Transplantation, 44(12), 793–797.
Leitch, H.A. (2011). Controversies surrounding iron chelation therapy for MDS. Blood Reviews, 25, 17–31.
List, A.F. (2010). Iron overload in myelodysplastic syndromes: diagnosis and management. Cancer Control, 17(Suppl), 2–8.
Malcovati L., Porta, M.G., Pascutto, C., Invernizzi, R., Boni, M., Travaglino, E., Passamonti, F., … Cazzola M. (2005). Prognostic factors and life expectancy in myelodysplastic syndromes classified according to WHO criteria: A basis for clinical decision making. Journal of Clinical Oncology, 23(30), 7594–7603.
Malcovati, L. (2007). Impact of transfusion dependency and secondary iron overload on the survival of patients with myelodysplastic syndromes. Leukemia Research, 31(Suppl 3), S2–S6.
MDS Foundation. (2011). Anemia, Blood Transfusions, Iron Overload, and Myelodysplastic Syndromes: A Handbook for Adult MDS Patients. Retrieved from http://www.mds-foundation.org/pdf/AnemiaBloodTransfusionsIronOverloadAndMDS-5-16-11.pdf
Meyer, S.C., O’Meara, A., Buser, A.S., Tichelli, A., Passweg, J.R., & Stern, M. (2013). Prognostic impact of posttransplantation iron overload after allogeneic stem cell transplantation. Biology of Blood and Marrow Transplantation, 19(3), 440–444.
National Comprehensive Cancer Network. (2015). NCCN Clinical Practice Guidelines in Oncology: Myelodysplastic Syndromes. Version 1.2015. Available at: http://www.nccn.org/professionals/physician_gls/pdf/mds.pdf
Pieracci, F.M., & Barie, P.S. (2005). Iron and the risk of infection. Surgical Infections, 6(Suppl 1), S41–S46.
Porter, J.B. (2001). Practical management of iron overload. British Journal of Haematology, 115, 239–252.
Pullarkat, V. (2010). Iron overload in patients undergoing hematopoietic stem cell transplantation. Advances in Hematology, 2010.
Pullarkat, V., Blanchard, S., Tegtmeier, B., Dagis, A., Patane, K., Ito, J., & Forman, S.J. (2008). Iron overload adversely affects outcome of allogeneic hematopoietic cell transplantation. Bone Marrow Transplantation, 42, 799–805.
Sanz, G., Nomdedeu, B., Such, E., Bernal, T., Belkaid, M., Ardanaz, M.T., … Cervera, J. (2008). Independent impact of iron overload and transfusion dependency on survival and leukemic evolution in patients with myelodysplastic syndrome [Abstract 640]. Blood, 112, 238–239.
Schafer, A.I., Cheron, R.G., Dluhy, R., Cooper, B., Gleason, R.E., Soeldner, J.S., & Bunn, H.F. (1981). Clinical consequences of acquired transfusional iron overload in adults. New England Journal of Medicine, 304(6), 319–24.
Shah, J., Kurtin, S.E., Arnold, L., Lindroos-Kolqvist, P. & Tinsley, S. (2012). Management of transfusion-related iron overload in patients with myelodysplastic syndromes. Clinical Journal of Oncology Nursing, 16(Suppl), 37–46.
Steensma, D.P. (2011). The relevance of iron overload and the appropriateness of iron chelation therapy for patients with myelodysplastic syndromes: A dialogue and debate. Current Hematologic Malignancy Reports, 6(2), 136–144.
Stein, J., Hartmann, F., & Dignass, A.U. (2010). Diagnosis and management of iron deficiency anemia in patients with IBD. Nature Reviews Gastroenterology & Hepatology, 7(11), 599–610.
Taher, A., Al Jefri, A., Elalfy, M.S., Al Zir, K., Daar, S., Rofail, D., Baladi, J.F., Habr, D., Kriemler-Krahn, U., & El-Beshlawy, A. (2010). Improved treatment satisfaction and convenience with deferasirox in iron-overloaded patients with beta-Thalassemia: Results from the ESCALATOR Trial. Acta Haematologica, 123(4), 220–225.
Takatoku, M., Uchiyama, T., Okamoto, S., Kanakura, Y., Sawada, K., Tomonaga, M., Nakao, S., … Japanese National Research Group on Idiopathic Bone Marrow Failure Syndromes. (2007). Retrospective nationwide survey of Japanese patients with transfusion-dependent MDS and aplastic anemia highlights the negative impact of iron overload on morbidity/mortality. European Journal of Haematology, 78(6), 487–494.
Trottier, B.J., Burns, L.J., DeFor, T.E., Cooley, S. & Majhail, N.S. (2013). Association of iron overload with allogeneic hematopoietic cell transplantation outcomes: A prospective cohort study using R2-MRI-measured liver iron content. Blood, 122(9), 1678–84.
University Health Network (UHN). (2012). Guidelines for the Care of Patients in the UHN Red Blood Cell Disorders Program. Available at: http://lgdata.s3-website-us-east-1.amazonaws.com/docs/1099/501764/UHN_RBCDP_Guidelines_For_Care_2012.pdf
Vichinsky, E. (2008). Clinical application of deferasirox: practical patient management. American Journal of Hematology, 83(5), 398–402.
Wells, R.A., Leber, B., Buckstein, R., Lipton, J.H., Hasegawa, W., Grewal, K., Yee, K., … Tinmouth, A. (2008). Iron overload in myelodysplastic syndromes: A Canadian consensus guideline. Leukemia Research, 32(9), 1338–1353.
Zurlo, M.G., De Stefano, P., Borgna-Pignatti., C., Di Palma, A., Piga, A., Melevendi, C., Di Gregorio, F., … Terzoli, S. (1989). Survival and causes of death in thalassaemia major. Lancet, 2(8653), 27–30.
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