For the past 2-6 years, two groups of
thalassemia patients, one of 16 patients on
deferoxamine (DFO) monotherapy (35-80 mg/kg, 2-5 days/week) and the other group comprising 19 patients on a
deferiprone (L1) and DFO combination
therapy (L1 75-100 mg/kg/day and DFO 30-60 mg/kg, 1-5 days/week), have been studied and compared before and after the introduction of the combination
therapy. The patients on the combination
therapy were mainly those not complying or experiencing toxicity with DFO. The effects of
chelation therapy on
iron load was monitored using regular serum
ferritin measurements and also magnetic resonance imaging (MRI) T2* relaxation time measurements at the end of the study. In both groups, cardiac MRI T2* levels were within the normal range (>19 ms) in more than 75% of the patients. There was a substantial improvement in serum
ferritin levels and normalization of the MRI T2* levels of the liver in many cases treated with the combination
therapy at effective doses by comparison to the DFO group, where the serum
ferritin and MRI T2* levels were largely unchanged. It would appear that the major overall determining factor in the rapid clearance of excess
iron in
thalassemia patients and the maintenance of normal
iron stores is the selection and implementation of effective chelation dose protocols. The International Committee on Chelation (ICOC) combination protocol L1 (80-110 mg/kg/day)/DFO (40-60 mg/kg at least 3 days per week) and to a lesser extent, DFO monotherapy at about 50 mg/kg/day, 5 days/week, appears to achieve this goal.