Advantages and disadvantages of phlebotomy and iron chelation following hematopoietic cell transplantation

	Advantages	Disadvantages
Phlebotomy	Efficient Safe Inexpensive Permits complete iron removal and normalizes body iron content Iron removal is quantifiable	Requires sustained engraftment (not usable in the early post-transplant period) Immediate effect on plasma iron/non-transferrin-bound iron Requires access to a phlebotomy facility Not appropriate for individuals with mixed chimerism
Iron chelation therapy	Efficient Safe Immediate effect on plasma iron/non-transferrin-bound iron unknown Access to a phlebotomy facility not required Can be used in individuals with hemoglobin <10 g/dL Can be used in individuals with mixed chimerism	Expensive Renal toxicity in patients receiving cyclosporine Greater toxicity at lower levels of iron burden

Hepatic iron concentration is assessed at 18 months following hematopoietic HCT, after the patient is no longer receiving transplant-related medications. Refer to UpToDate for additional information regarding the management of the patient with thalassemia following HCT and additional details regarding iron chelating agents.

HCT: hematopoietic cell transplantation.

Courtesy of Emanuele Angelucci, MD

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Advantages and disadvantages of phlebotomy and iron chelation following hematopoietic cell transplantation