Long-term chelation therapy with deferoxamine is an effective and generally safe method for removing excessive iron, preventing iron-induced organ damage and improving survival of patients with transfusion-dependent disorders. The current treatment of iron overload is an important standard against which new forms of therapy, such as oral chelators, should be measured to ensure that their risks and benefits compare favorably with deferoxamine. Until new treatments are available, continuing studies of deferoxamine will help to define its long-term efficacy and toxicity for patients with thalassemia major and other hematologic disorders.