{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T04:34:37Z","timestamp":1778733277996,"version":"3.51.4"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T00:00:00Z","timestamp":1611273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>There is limited data on iron reduction therapy (IRT) after successful allogeneic haematopoietic stem cell transplantation (aHSCT) for patients with thalassemia major (TM). We present the long term outcome of IRT in 149 patients with TM who underwent aHSCT during January, 2001-December, 2012. The median age was 7 years (range:1\u201318) and 92 (61.7%) belonged to Pesaro class 3 with a median ferritin at aHSCT of 2480ng\/ml (range:866\u20138921). IRT was reinitiated post-aHSCT at a median of 14 months (range:5\u201353) post aHSCT with phlebotomy alone in 10 (6.7%) patients or iron chelation alone in 60 (40.3%) patients while 79 (53%) were treated with the combination. Reduction in serum ferritin\/month [absolute quantity (ng\/ml\/month) was as follows: 87 (range:33\u2013195), 130 (range:17\u20131012) and 147 (range:27.7\u20131427) in the phlebotomy, chelation and combination therapy groups, respectively (p = 0.038). With a median follow up of 80 months (range:37\u2013182), target ferritin level of &lt;300ng\/ml was achieved in 59(40%) while a level &lt;500ng\/ml was achieved in 88 patients (59%) in a median duration of 41 months of IRT (range: 3\u2013136). Patients in class III risk category and higher starting serum ferritin levels (&gt;2500ng\/ml) were associated with delayed responses to IRT. Our data shows that IRT may be needed for very long periods in ex-thalassaemics to achieve target ferritin levels and should therefore be carefully planned and initiated as soon as possible after aHSCT. A combination of phlebotomy and iron chelators is more effective in reducing iron overload.<\/jats:p>","DOI":"10.1371\/journal.pone.0238793","type":"journal-article","created":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T22:01:01Z","timestamp":1611352861000},"page":"e0238793","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Outcome of iron reduction therapy in ex-thalassemics"],"prefix":"10.1371","volume":"16","author":[{"given":"Fouzia N.","family":"Aboobacker","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaurav","family":"Dixit","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kavitha M.","family":"Lakshmi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anu","family":"Korula","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aby","family":"Abraham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Biju","family":"George","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vikram","family":"Mathews","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5032-5020","authenticated-orcid":true,"given":"Alok","family":"Srivastava","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,1,22]]},"reference":[{"key":"pone.0238793.ref001","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1056\/NEJM199002153220701","article-title":"Bone marrow transplantation in patients with Thalassemia","volume":"322","author":"G Lucarelli","year":"1990","journal-title":"N Engl J Med"},{"issue":"3","key":"pone.0238793.ref002","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1182\/blood.V90.3.994","article-title":"Phlebotomy to Reduce Iron Overload in Patients Cured of Thalassemia by Bone Marrow Transplantation","volume":"90","author":"E Angelucci","year":"1997","journal-title":"Blood"},{"key":"pone.0238793.ref003","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1056\/NEJM199409013310903","article-title":"Survival in medically treated patients with homozygous \u00df thalassemia","volume":"331","author":"NF Olivieri","year":"1994","journal-title":"N Engl J Med"},{"issue":"8884","key":"pone.0238793.ref004","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1016\/0140-6736(93)92753-G","article-title":"Fate of iron stores in thalassaemia after bone-marrow transplantation","volume":"342","author":"G Lucarelli","year":"1993","journal-title":"The Lancet"},{"issue":"4","key":"pone.0238793.ref005","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1111\/j.1365-2141.1995.tb08426.x","article-title":"Desferrioxamine therapy accelerates clearance of iron deposits after bone marrow transplantation for thalassaemia","volume":"89","author":"C Giardini","year":"2008","journal-title":"Br J Haematol"},{"issue":"6","key":"pone.0238793.ref006","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1038\/sj.bmt.1702212","article-title":"Early iron reduction programme for thalassaemia patients after bone marrow transplantation","volume":"25","author":"C Li","year":"2000","journal-title":"Bone Marrow Transplant"},{"issue":"5","key":"pone.0238793.ref007","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1182\/blood.V87.5.2082.2082","article-title":"Marrow transplantation for patients with thalassemia results in class 3 patients","volume":"87","author":"G Lucarelli","year":"1996","journal-title":"Blood"},{"issue":"8","key":"pone.0238793.ref008","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1016\/j.bbmt.2007.05.004","article-title":"A New Stratification Strategy That Identifies a Subset of Class III Patients with an Adverse Prognosis among Children with \u03b2 Thalassemia Major Undergoing a Matched Related Allogeneic Stem Cell Transplantation","volume":"13","author":"V Mathews","year":"2007","journal-title":"Biol Blood Marrow Transplant"},{"key":"pone.0238793.ref009","unstructured":"Taher A, Vichinsky EP, Musallam K, Cappellini M-D, Viprakasit V, Thalassaemia International Federation. 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