In transfusion-dependent, lower-risk MDS

Guidelines Recommend Chelating Patients
At Risk of Iron Toxicity

Approximately two-thirds of patients with myelodysplastic syndrome initially present with lower-risk disease. International guidelines recommend iron chelation for these patients once their transfusion therapy is underway.^1,2,3

See the National Comprehensive Cancer Network Guidelines

The National Comprehensive Cancer Network (NCCN), an alliance of the world's leading cancer centers, recommends iron chelation therapy in its 2009 Practice Guidelines in Oncology. Specifically, chelation is recommended for low or intermediate-1 patients who²:

Have received 20 transfusions
Are expected to receive 20 transfusions
Are expected to receive ongoing transfusions
Have a serum ferritin level >2500 μg/L

The NCCN defines the goal of chelation therapy as decreasing ferritin levels to <1000 μg/L.

See the Myelodysplastic Syndromes Foundation Guidelines

The Myelodysplastic Syndromes Foundation recommends the initiation of chelation therapy for³:

Transfusion-dependent patients requiring 2 units per month for one year or longer
Patients with ferritin levels >1000 μg/L
Patients with lower-risk MDS
- IPSS low or intermediate-1
- WHO RA, RARS, and 5q-
Patients with life expectancies of at least 1 year
Patients without comorbidities that would limit prognosis
Candidates for allograft
Patients in whom there is a need to preserve organ function

Click on the green content in the chart below to learn more about each step

CALCULATE MDS SEVERITY

Available for use online or as a downloadable version, the IPSS
Calculator can help you determine the appropriate risk level of your MDS
patients based on international
consensus guidelines.

Learn more

CHELATE WITH EXJADE

EXJADE reduces LIC
and serum ferritin in
transfused patients with
lower-risk myelodyspastic
syndrome.

Learn more

Identify Your Patients Who Will Benefit From Iron Chelation^3-10
International Prognostic Scoring System The International Prognostic Scoring System (IPSS) is a classification system for assessing clinical outcomes in myelodysplastic syndromes (MDS). It is used to evaluate risk stratification in clinical trials and aid with decision-making in clinical practice.⁵ The IPSS is based on 3 prognostic factors: Bone marrow blast cell percentage Cytogenetic pattern (karyotype) Number and degree of cytopenias Based on these and other prognostic factors, the IPSS stratifies patients into risk categories.⁵ Learn more World Health Organization Classification System The World Health Organization (WHO) classification system was developed to use newly available testing methods to improve on the older French-American-British (FAB) system. The FAB system proposed morphological criteria to distinguish between MDS and acute myeloid leukemia (AML) based mainly on bone marrow (BM) blast count and divided MDS into 5 subgroups based on blast percentages in the peripheral blood and BM.⁶ The WHO system includes the mandatory inclusion of cytogenetics in the diagnostic work-up. Other primary refinements are a more precise morphological classification and the redefinition of blast excess levels.⁶ Learn more Toxic iron accumulates rapidly 10.8 MONTHS—Iron toxicity may develop after as few as 20 lifetime transfused units, with serum ferritin >1000 μg/L^7,8 Lower-risk patients are living significantly longer⁹ 3.5–5.7 YEARS—Median survival range for lower-risk patients¹⁰ Pretransplantation iron toxicity exposes patients to worse outcomes Decreased overall 5-year survival¹¹ Increased risk of the following complications: Liver inflammation and venoocclusive disease¹² Mucositis and bacteremia^13,14 Progression of hepatic fibrosis¹⁵

Identify Your Patients Who Will Benefit From Iron Chelation^3-10

Identify Patients Who Will Benefit from Iron Chelation

International Prognostic Scoring System

The International Prognostic Scoring System (IPSS) is a classification system for assessing clinical outcomes in myelodysplastic syndromes (MDS). It is used to evaluate risk stratification in clinical trials and aid with decision-making in clinical practice.⁵

The IPSS is based on 3 prognostic factors:

Bone marrow blast cell percentage
Cytogenetic pattern (karyotype)
Number and degree of cytopenias

Based on these and other prognostic factors, the IPSS stratifies patients into risk categories.⁵

Learn more

World Health Organization Classification System

The World Health Organization (WHO) classification system was developed to use newly available testing methods to improve on the older French-American-British (FAB) system. The FAB system proposed morphological criteria to distinguish between MDS and acute myeloid leukemia (AML) based mainly on bone marrow (BM) blast count and divided MDS into 5 subgroups based on blast percentages in the peripheral blood and BM.⁶

The WHO system includes the mandatory inclusion of cytogenetics in the diagnostic work-up. Other primary refinements are a more precise morphological classification and the redefinition of blast excess levels.⁶

Learn more

Toxic iron accumulates rapidly

10.8 MONTHS—Iron toxicity may develop after as few as 20 lifetime transfused units, with serum ferritin >1000 μg/L^7,8

Lower-risk patients are living significantly longer⁹

3.5–5.7 YEARS—Median survival range for lower-risk patients¹⁰

Pretransplantation iron toxicity exposes patients to worse outcomes

Decreased overall 5-year survival¹¹

Increased risk of the following complications:

Liver inflammation and venoocclusive disease¹²
Mucositis and bacteremia^13,14
Progression of hepatic fibrosis¹⁵

More Information

IPSS IPSS Calculator WHO Classification

EU SmPC

Efficacy

References

Goldberg SL. Novel treatment options for transfusional iron overload in patients with myelodysplastic syndromes. Leuk Res. 2007;31(suppl 3):S16-S22.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: myelodysplastic syndromes. v.1.2009.
Bennett JM; for the MDS Foundation's Working Group on Transfusional Iron Overload. Am J Hematol. 2008;83(11):858-861.
Gattermann N. Overview of guidelines on iron chelation therapy in patients with myelodysplastic syndromes and transfusional iron overload. Int J Hematol. 2008;88:24-29.
Greenberg P, Cox C, LeBeau MM, et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood.1997;89(6):2079-2088.
Classification of myelodysplastic syndromes. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/myelodysplastic/HealthProfessional/page2. Updated March 19, 2010. Accessed October 12, 2010.
Malcovati L, Della Porta MG, Pascutto C, et al. Prognostic factors and life expectancy in myelodysplastic syndromes classified according to WHO Criteria: A basis for clinical decision making. J Clin Oncol. 2005;23(30):7594-7603.
Porter JB. Practical management of iron overload[review]. Br J Haematol. 2001;115(2):239-252.
Dayyani F, Conley AP, Strom SS, et al. Cause of death in patients with lower-risk myelodysplastic syndrome. Cancer. 2010;116(9):2174-2179.
Greenberg PL. Myelodysplastic syndromes. Hematology Am Soc Hematol Educ Program. 2002:136-161.

Welcome to the EXJADE Product Website

EXJADE is approved for use in 108 countries around the world.

EXJADE Country-Level Websites

EXJADE International Website

In this section:

In transfusion-dependent, lower-risk MDS

Guidelines Recommend Chelating Patients
At Risk of Iron Toxicity

CALCULATE MDS SEVERITY

CHELATE WITH EXJADE

International Prognostic Scoring System

World Health Organization Classification System

Toxic iron accumulates rapidly

Lower-risk patients are living significantly longer⁹

Pretransplantation iron toxicity exposes patients to worse outcomes

Welcome to the EXJADE Product Website

EXJADE is approved for use in 108 countries around the world.

EXJADE Country-Level Websites

EXJADE International Website

In this section:

In transfusion-dependent, lower-risk MDS

Guidelines Recommend Chelating Patients At Risk of Iron Toxicity

CALCULATE MDS SEVERITY

CHELATE WITH EXJADE

International Prognostic Scoring System

World Health Organization Classification System

Toxic iron accumulates rapidly

Lower-risk patients are living significantly longer9

Pretransplantation iron toxicity exposes patients to worse outcomes

Guidelines Recommend Chelating Patients
At Risk of Iron Toxicity

Lower-risk patients are living significantly longer⁹