Prevalence and distribution of iron overload in patients with transfusion-dependent anemias differs across geographic regions: results from the CORDELIA study

Eur J Haematol. 2015 Sep;95(3):244-53. doi: 10.1111/ejh.12487. Epub 2015 Jan 8.


Objectives: The randomized comparison of deferasirox to deferoxamine for myocardial iron removal in patients with transfusion-dependent anemias (CORDELIA) gave the opportunity to assess relative prevalence and body distribution of iron overload in screened patients.

Methods: Patients aged ≥ 10 yr with transfusion-dependent anemias from 11 countries were screened. Data were summarized descriptively, overall and across regions.

Results: Among 925 patients (99.1% with β-thalassemia major; 98.5% receiving prior chelation; mean age 19.2 yr), 36.7% had myocardial iron overload (myocardial T2* ≤ 20 ms), 12.1% had low left ventricular ejection fraction. Liver iron concentration (LIC) (mean 25.8 mg Fe/g dw) and serum ferritin (median 3702 ng/mL) were high. Fewer patients in the Middle East (ME; 28.5%) had myocardial T2* ≤ 20 ms vs. patients in the West (45.9%) and Far East (FE, 40.9%). Patients in the West had highest myocardial iron burden, but lowest LIC (26.9% with LIC < 7 mg Fe/g dw) and serum ferritin. Among patients with normal myocardial iron, a higher proportion of patients from the ME and FE had LIC ≥ 15 than < 7 mg Fe/g dw (ME, 56.7% vs. 17.2%; FE, 78.6% vs. 7.8%, respectively), a trend which was less evident in the West (44.6% vs. 33.9%, respectively). Transfusion and chelation practices differed between regions.

Conclusions: Evidence of substantial myocardial and liver iron burden across regions revealed a need for optimization of effective, convenient iron chelation regimens. Significant regional variation exists in myocardial and liver iron loading that are not well explained; improved understanding of factors contributing to differences in body iron distribution may be of clinical benefit.

Keywords: distribution; heart; iron; liver; prevalence; thalassemia.

Publication types

  • Clinical Trial, Phase II
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anemia / complications*
  • Anemia / therapy
  • Child
  • Deferoxamine / therapeutic use
  • Female
  • Humans
  • Iron / metabolism
  • Iron Chelating Agents / therapeutic use
  • Iron Overload / drug therapy
  • Iron Overload / epidemiology*
  • Iron Overload / etiology*
  • Iron Overload / metabolism
  • Liver / metabolism
  • Liver / pathology
  • Male
  • Middle Aged
  • Myocardium / metabolism
  • Myocardium / pathology
  • Prevalence
  • Tissue Distribution
  • Transfusion Reaction*
  • Young Adult


  • Iron Chelating Agents
  • Iron
  • Deferoxamine