We herein report a case of a thalassemic-patient who was on deferasirox chelation therapy and admitted to the emergency department because of fever, diffuse abdominal pain and altered mental status. Despite the appropriate treatment he died two days later due to cardiac arrest. As we failed to recognize any etiology and the patients’ relatives denied a post mortem examination due to religious reasons, we cannot provide any additional data. However, we are wondering whether this incident might be related to deferasirox.
Borgna-Pignatti C., Cappellini MD, De Stefano P., et al. Cardiac morbidity and mortality in deferoxamine- or deferiprone-treated patients with thalassemia major. Blood. 2006;107(9):3733-3737.
2.
Ladis V., Chouliaras G., Berdoukas V., et al. Relation of chelation regimes to cardiac mortality and morbidity in patients with thalassaemia major: an observational study from a large Greek Unit. Eur J Haematol.2010;85(4):335-344.
3.
Vlachaki E., Ioannidou-Papagiannaki E., Tziomalos K., et al. Peripheral blood haematopoietic progenitor cells in patients with beta thalassaemia major receiving desferrioxamine or deferiprone as chelation therapy. Eur J Haematol. 2007;78(1):48-51.
4.
Ruffo GB, Borsellino Z., Cuccia L., Marocco MR, Gagliardotto F., Tarantino R.Long-term chelation therapy with deferasirox: effects on cardiac iron overload measured by T2* MRI. Clin Drug Investig.2010 ;30(4):267-273.
5.
Pennell DJ, Porter JB, Cappellini MD, et al. Efficacy of deferasirox in reducing and preventing cardiac iron overload in beta-thalassemia. Blood.2010;115(12):2364-2371.
6.
Vichinsky E.Clinical application of deferasirox: practical patient management. Am J Hematol. 2008;83(5):398-402.
7.
Kontoghiorghes GJTransparency and access to full information for the fatal or serious toxicity risks, low efficacy and high price of deferasirox, could increase the prospect of improved iron chelation therapy worldwide. Hemoglobin. 2008;32(6):608-615.
8.
Kontoghiorghes GJEthical issues and risk/benefit assessment of iron chelation therapy: advances with deferiprone/deferoxamine combinations and concerns about the safety, efficacy and costs of deferasirox. Hemoglobin. 2008;32(6):1-15.
9.
Porter JB, Taher AT, Cappellini MD, Vichinsky EPEthical issues and risk/benefit assessment of iron chelation therapy: advances with deferiprone/deferoxamine combinations and concerns about the safety, efficacy and costs of deferasirox[Kontoghiorghes GJ, Hemoglobin. 2008;32(1-2):1-15.]. Hemoglobin. 2008;32(6):601-607.
10.
Briguori C. , Airoldi F., D’Andrea D., et al. Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): a randomized comparison of 3 preventive strategies. Circulation. 2007 ;115(10):1211-1217.
11.
Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJMultiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23(10): 1638-1652.
12.
Krinsley JS, Grover A.Severe hypoglycemia in critically ill patients: risk factors and outcomes . Crit Care Med. 2007; 35(10):2262-2267.
13.
Miller SI, Wallace RJ Jr, Musher DM, Septimus EJ, Kohl S., Baughn REHypoglycemia as a manifestation of sepsis. Am J Med. 1980;68(5):649-654.
14.
Kato GJ, Taylor JGt. Pleiotropic effects of intravascular haemolysis on vascular homeostasis . Br J Haematol.2010;148(5):690-701.
15.
Kontoghiorghes GJIntroduction of higher doses of deferasirox: better efficacy but not effective iron removal from the heart and increased risks of serious toxicities. Expert Opin Drug Saf.2010;9(4):633-641.
16.
Papadopoulos N., Vasiliki A., Aloizos G., Tapinis P., Kikilas A.Hyperchloremic metabolic acidosis due to deferasirox in a patient with beta thalassemia major. Ann Pharmacother.2010; 44(1):219-221.
17.
Messa E., Carturan S., Maffe C., et al. Deferasirox is a powerful NF-kappaB inhibitor in myelodysplastic cells and in leukemia cell lines acting independently from cell iron deprivation by chelation and reactive oxygen species scavenging. Haematologica.2010; 95(8):1308-1316.
18.
Liu SF, Malik ABNF-kappa B activation as a pathological mechanism of septic shock and inflammation . Am J Physiol Lung Cell Mol Physiol. 2006 ;290(4):L622-L645.
19.
Li X., Su J., Cui X., Li Y., Barochia A., Eichacker PQCan we predict the effects of NF-kappaB inhibition in sepsis? Studies with parthenolide and ethyl pyruvate. Expert Opin Investig Drugs.2009;18(8):1047-1060.
