Iron chelation for myelofibrosis-related anaemia during treatment with a Janus kinase inhibitor

Anaemia is one of the cardinal manifestations of myelofibrosis (MF) and is an adverse prognostic factor associated with shortened overall survival. Transfusion-dependence leads to iron overload with the associated risk of infection as well as endocrine, hepatic and cardiac complications. The use of iron chelation has been studied most extensively in diseases such as thalassaemia and lower risk myelodysplastic syndromes. However, data on the efficacy and safety of iron chelation in MF remain limited, perhaps due to the rarity and shortened survival of this group of patients.

Ruxolitinib, a Janus kinase JAK1/JAK2 inhibitor, is approved in many countries as a first-line treatment for symptomatic MF. Its beneficial effects are mediated, at least in part, by a reduction in pro-inflammatory cytokines...