I. PHARMACOKINETICS, METABOLISM AND TOXICITY OF DEFEROXAMINE AND OTHER IRON CHELATORS

Transfusion therapy for inherited anemias and acquired refractory anemias both improves the quality of life and prolongs survival. A conse-quence of chronic transfusion therapy is secondary iron overload, which adversely affects the function of the heart, the liver and other organs. This ses-sion will review the use of iron chelating agents in the management of transfusion-induced secondary iron overload. In Section I Dr. John Porter describes tech-niques for the administration of deferoxamine that exploit the pharmacokinetic properties of the drug and minimize potential toxic side effects. The experience with chelation therapy in patients with thalassemia and sickle cell disease will be reviewed and guidelines will be suggested for chelation therapy of chronically transfused adults with refractory anemias. In Section II Dr. Nancy Olivieri examines the clinical consequences of transfusion-induced secondary iron overload and suggests criteria useful in determining the optimal timing of the initiation of chelation therapy. Finally, Dr. Olivieri discusses the clinical trials evaluating orally administered iron chelators