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Accreditation/ Credit Designation

Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. These activites are not approved for AMA PRA Category 1 Credit™.

Acknowledgement of Commercial Support

This activity is supported by an educational grant from Novartis Pharmaceuticals Corporation.


Oncology Briefings™: Overcoming Chronic Iron Overload in Pediatric AML and MDS PER Pulse™ Recap

PER Pulse Recap

PER Pulse™ Recap


1 of 3
PER Pulse™ Recap

Describing and Detecting Iron Overload

The online Oncology Briefings™ CME activity, Overcoming Chronic Iron Overload in Pediatric AML and MDS, provides oncologists and other healthcare professionals with an engaging presentation on the current and emerging treatment standards for pediatric patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Leading experts Elias J. Jabbour, MD, associate professor and section chief in ALL in the Department of Leukemia, Division of Cancer Medicine, at The University of Texas MD Anderson Cancer Center, Houston, Texas; and Latika Puri, MD, pediatric hematologist-oncologist at Le Bonheur Children’s Hospital and St. Jude Children’s Research Hospital, Memphis, Tennessee, answer key questions supported by the presentation of clinical science about AML and MDS. This first of 3 PER Pulse™ Recaps from this program focuses on the underlying biology of iron overload and how to detect it in your pediatric patients.

Drs. Jabbour and Puri discussed the risk of developing chronic iron overload in patients with AML or MDS, and detailed key approaches on how to detect and address high iron levels and deposition:

  • Under normal physiological conditions, iron uptake is regulated by the binding of transferrin to its receptors on hepatocytes in the liver and erythrocyte precursor cells in the bone marrow. When overloaded, transferrin receptors cannot bind additional iron, resulting in plasma as non‒transferrin-bound iron (NTBI) that is readily taken up by the liver, heart, and other organs.
  • Each unit of red blood cells given as a transfusion contains 200 to 250 mg of iron, which can result in iron-overloaded patients after as few as 10 transfusions. Patients with AML, MDS, or other hematologic malignancies are particularly susceptible to iron overload. For example, patients with AML may require upwards of 30 blood product transfusions in the induction phase alone, and potentially 150 donations over an entire course of therapy.
  • Iron levels can be determined by measuring serum ferritin in units of ng/mL; patients with levels above 1000 ng/mL are considered overloaded. Liver iron concentration (LIC) is also standard for measuring body-iron stores; LIC greater than 3 mg/g dry weight is considered overloaded. LIC can be measured by direct biopsy or by T2 or T2* MRI.

For additional information and commentary on this topic, as well as audio and supporting text, visit http://www.gotoper.com/online-cme-activities/oncology-briefing/oncology-briefings-overcoming-chronic-iron-overload-in-pediatric-aml-and-mds.

For information on other topics, visit www.gotoper.com or www.AJHO.com.


2 of 3
PER Pulse™ Recap

Treating Patients With Iron Overload

The online Oncology Briefings™ CME activity, Overcoming Chronic Iron Overload in Pediatric AML and MDS, provides oncologists and other healthcare professionals with an engaging presentation on the current and emerging treatment standards for pediatric patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Leading experts Elias J. Jabbour, MD, associate professor and section chief in ALL in the Department of Leukemia, Division of Cancer Medicine, at The University of Texas MD Anderson Cancer Center, Houston, Texas; and Latika Puri, MD, pediatric hematologist-oncologist at Le Bonheur Children’s Hospital and St. Jude Children’s Research Hospital, Memphis, Tennessee, answer key questions supported by the presentation of clinical science about AML and MDS. This second of 3 PER Pulse™ Recaps from this program focuses on the current treatments for pediatric patients with chronic iron overload, following treatment for AML or MDS.

Drs. Jabbour and Puri outlined the standard treatment options for chronic iron overload in pediatric patients with AML or MDS, and discussed challenges faced when treating this condition, specifically:

  • In patients who are not transfusion-dependent, phlebotomy is the standard method of practical chelation. In transfusion-dependent patients this is not an option. Instead, iron chelators work to reduce iron burden, controlling the rate of iron accumulation by increasing the rates of iron binding and excretion.
  • The National Comprehensive Cancer Network (NCCN) recommends chelation therapy for patients who have received or are expected to receive 20 transfusions, or those who have a serum ferritin level greater than 2500 ng/mL. The goal of chelation therapy is to reduce serum ferritin levels to below 1000 ng/mL.
  • There are currently 3 iron chelators approved by the US Food and Drug Administration: deferoxamine, approved in 1968, requires a subcutaneous or intravenous administration; deferasirox, approved in 2005, is an oral tablet taken once daily; and, deferiprone, another orally delivered iron chelator, approved in 2011.
  • Investigations into future treatment options and strategies include ongoing trials studying new combinations or formulations of existing, approved chelators.

For additional information and commentary on this topic, as well as audio and supporting text, visit http://www.gotoper.com/online-cme-activities/oncology-briefing/oncology-briefings-overcoming-chronic-iron-overload-in-pediatric-aml-and-mds.

For information on other topics, visit www.gotoper.com or www.AJHO.com.


3 of 3
PER Pulse™ Recap

Methods to Ensure Patient Compliance

The online Oncology Briefings™ CME activity, Overcoming Chronic Iron Overload in Pediatric AML and MDS, provides oncologists and other healthcare professionals with an engaging presentation on the current and emerging treatment standards for pediatric patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Leading experts Elias J. Jabbour, MD, associate professor and section chief in ALL in the Department of Leukemia, Division of Cancer Medicine, at The University of Texas MD Anderson Cancer Center, Houston, Texas; and Latika Puri, MD, pediatric hematologist-oncologist at Le Bonheur Children’s Hospital and St. Jude Children’s Research Hospital, Memphis, Tennessee, answer key questions supported by the presentation of clinical science about AML and MDS. This third and final PER Pulse™ Recap from this program focuses on the essential practices to ensure treatment compliance in a pediatric population.

Drs. Jabbour and Puri discussed their approaches to patient compliance when treating chronic iron overload in a pediatric population. Topics included novel strategies and approaches to incorporate into practice:

  • Adherence to chelation therapy is critical and often challenging issue for patients due to the lengthy duration of treatment. Poor adherence can result from issues such as infusion difficulty, patient intolerance, or family and environmental factors.
  • Drs. Jabbour and Puri emphasized the vital role of patient education. Comprehensive information on chronic iron overload, its associated risk, patients’ current overload status, the function of treatment, and potential adverse events associated with treatment are all essential in working to ensure compliance.
  • As pediatric patients age and engage in more active lifestyles, compliance becomes an increasingly challenging issue, requiring specific attention from healthcare providers. Strategies to incorporate include: treatment management apps; continuous education and reinforcement; and coordination with a network of social workers, patient advocates, pharmacists, and family members.

For additional information and commentary on this topic, as well as audio and supporting text, visit http://www.gotoper.com/online-cme-activities/oncology-briefing/oncology-briefings-overcoming-chronic-iron-overload-in-pediatric-aml-and-mds.

For information on other topics, visit www.gotoper.com or www.AJHO.com.





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