Evaluation of the Efficacy and Safety of Alternating Chelation Therapy in Transfusion-Dependent Thalassemia

To evaluate the efficacy and safety of weekly alternating deferasirox-deferiprone (DFX-DFP) therapy in patients with transfusion-dependent thalassemia and iron overload. This single-center retrospective study included 14 patients; because one patient had two treatment periods, 15 periods were analyzed. Patients received DFX for 3 consecutive days and DFP for 4 consecutive days in weekly cycles. Response was assessed by serum ferritin and cardiac and hepatic T2* MRI. Safety was evaluated using laboratory parameters and clinical adverse events. Pre- and post-treatment values were compared using the Wilcoxon signed-rank test. Median age at treatment initiation was 34 years (IQR: 20-37), and median treatment duration was 16 months (IQR: 12-22). Median baseline ferritin was 1571 μg/L (IQR: 1160-3001) and decreased significantly by month 3 (p = 0.006). Baseline cardiac T2* was <20 ms in 86.6% of periods. Median cardiac T2* increased from 10 ms (IQR: 8.5-15) to 21 ms (IQR: 9.9-30; p = 0.005). Hepatic T2* increased nonsignificantly (p = 0.151). Adverse events were manageable and included transient neutropenia, grade 2 hypertransaminasemia, increased creatinine, and nausea. Weekly alternating DFX-DFP therapy was associated with early ferritin reduction at month 3 and significant cardiac T2* improvement, with manageable adverse events.