Incidence of Deferiprone-induced Neutropenia in Patients with Thalassemia and Iron Overload
MDKanyaporn Supim MD¹, Oraphan Kongpanvijit MD²
Affiliation : ¹ Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, ² Division of Hematology, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Background: Thalassemia is an inherited disease that causes abnormal hemoglobin synthesis and the subsequent loss of erythrocytes. Blood transfusions and iron chelators are used as important treatments. Deferiprone, an effective oral iron chelator, can have significant side effects, including neutropenia.
Objective: To determine the incidence of deferiprone-induced neutropenia in patients with thalassemia and assess the efficacy of deferiprone along with other side effects.
Materials and Methods: This retrospective cohort study examined patients with thalassemia aged 15 years who were treated with deferiprone between January 2011 and December 2019. The reported incidence rate of neutropenia is 100 per 100 person-year. Basic variables were compared between patients with or without neutropenia, with the correlation being significant at p<0.05.
Results: In total, 162 patients with thalassemia aged 15 years or older were treated with deferiprone. The mean age of patients was 42.19±19.05 years, and 92 patients (60%) were female. Beta-thalassemia HbE was present in 92 patients (56.8%). In total, 81 patients (50%) were dependent on blood transfusions, and 109 patients (67.3%) had not undergone splenectomy. Deferiprone-induced neutropenia occurred in 26 patients, and were categorized as three cases of agranulocytosis, 5 cases of moderate neutropenia, and 18 cases of mild neutropenia. The incidence rates of agranulocytosis and neutropenia were 0.38 and 3.22 per 100 person-year, respectively. The dosage of deferiprone that caused neutropenia was 35.4 mg/kg/day (20 to 50 mg/kg/day). The period of occurrence was 664 days (363 to 1,176 days). Deferiprone reduced serum ferritin levels from baseline by 15.92±29.71, and 18.41±39.65 ng/mL after 6 and 12 months of treatment. Common side effects included nausea (4.3%) and joint pain (3.7%).
Conclusion: Incidence rates of agranulocytosis and neutropenia were 0.38 and 3.22 per 100 person-year, respectively. Deferiprone reduced serum ferritin levels from the baseline by 16% and 18% after 6 and 12 months of treatment, respectively.
Received 8 September 2023 | Revised 12 March 2024 | Accepted 2 May 2024
Keywords : Neutropenia; Deferiprone; Iron Overload Thalassemia; Agranulocytosis
