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Peter L. Greenberg, Cynthia K. Rigsby, Richard M. Stone, H. Joachim Deeg, Steven D. Gore, Michael M. Millenson, Stephen D. Nimer, Margaret R. O'Donnell, Paul J. Shami and Rashmi Kumar

1997 ; 89 : 739 – 761 . 6 Malcovati L . Impact of transfusion dependency and secondary iron overload on the survival of patients with myelodysplastic syndromes . Leuk Res 2007 ; 31 ( Suppl 3 ): S2 – 6 . 7 Andrews NC . Iron

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Peter L. Greenberg

transfusional iron overload in adults . N Engl J Med 1981 ; 304 : 319 – 324 . 5. Jaeger M Aul C Sohngen D . Iron overload in polytransfused patients with MDS: the use of L1 for oral iron chelation . Drugs Today 1992 ; 28 [ suppl A ]: 143 – 147

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7 7 Suppl_9 Suppl_9 NCCN Task Force: Transfusion and Iron Overload in Patients With Myelodysplastic Syndromes Greenberg Peter L. MD Rigsby Cynthia K. MD Stone Richard M. MD Deeg H. Joachim MD Gore Steven D. MD

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David P. Steensma

: January 6, 2011; Expiration date: January 6, 2012 Learning Objectives Upon completion of this activity, participants will be able to: Describe the association between MDS and anemia Evaluate iron overload in patients with MDS Distinguish benefits of iron

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Now Available Online: NCCN Task Force: Transfusion and Iron Overload in Patients With Myelodysplastic Syndromes In October 2009, NCCN convened a multidisciplinary task force to critically review the evidence for iron chelation and the

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Jeffrey A. Gilreath, David D. Stenehjem and George M. Rodgers

raised, such as oxidative stress, infection risk, iron overload, venous thromboembolism (VTE), and tumor growth. 7 , 9 , 10 Patients with cancer may be at a higher risk for some of these long-term adverse effects because of more frequent blood

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Peter L. Greenberg, Leon E. Cosler, Salvatore A. Ferro and Gary H. Lyman

Guidelines for management of patients with myelodysplastic syndromes (MDS) have been generated by the National Comprehensive Cancer Network (NCCN) Myelodysplastic Syndromes Panel. Because MDS is a heterogeneous spectrum of disorders, these patients have been categorized into prognostic subgroups, predominantly using the International Prognostic Scoring System (IPSS). Several drugs have been used to treat these patients, and their selection and sequential recommended use by the panel depend on disease characteristics and responses to treatment. Recombinant erythropoietin alfa and darbepoetin alfa have been the mainstay of therapy for treating anemia associated with MDS. The FDA has recently approved several other drugs for treating MDS, including azacytidine and decitabine for all stages of disease, lenalidomide for low-risk anemic patients with del(5q) chromosomal abnormality, and deferasirox for treating iron overload. For iron chelation, deferoxamine is also used occasionally. Treatment with immunosuppressive therapy (antithymocyte globulin and cyclosporin) has been therapeutically beneficial for a subset of younger patients with MDS. Because the financial cost of these therapies are substantial and have received only limited attention, this article evaluates the costs of specific drugs and their sequential use in the lower-risk IPSS (low and intermediate-1) subgroups based on the NCCN guidelines. Results estimate an average annual cost for potentially anemia-altering drugs of $63,577 per patient, ranging from $26,000 to $95,000, depending on the specific therapies. In patients for whom the therapies fail, annual costs for iron chelation plus red blood cell transfusions are estimated to average $41,412. The economic impact of drug therapy should be weighed against the patient's potential for improvement in clinical outcomes, quality of life, and transfusion requirements.

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Steven D. MD 01 2006 4 4 1 1 83 83 90 90 0040083 10.6004/jnccn.2006.0009 Myelodysplastic Syndromes: Iron Overload Consequences and Current Chelating Therapies Greenberg Peter L. MD 01 2006 4 4 1 1 91 91 96 96 0040091 10.6004/jnccn.2006.0010

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Peter L. Greenberg, Eyal Attar, John M. Bennett, Clara D. Bloomfield, Carlos M. De Castro, H. Joachim Deeg, James M. Foran, Karin Gaensler, Guillermo Garcia-Manero, Steven D. Gore, David Head, Rami Komrokji, Lori J. Maness, Michael Millenson, Stephen D. Nimer, Margaret R. O'Donnell, Mark A. Schroeder, Paul J. Shami, Richard M. Stone, James E. Thompson and Peter Westervelt

patients with MDS with recurrent or resistant bacterial infections. The use of recombinant human erythropoietin to treat symptomatic anemia is discussed in Evaluation and Treatment of Related Anemia (see page 49). Management of Iron Overload: RBC