Prospective changes of pancreatic iron in patients with thalassemia major and association with chelation therapy.

We prospectively evaluated in thalassemia major (TM) patients the changes in pancreatic iron levels assessed by T2* magnetic resonance imaging (MRI), their dependence on total body iron balance, and their association with the different iron chelators in monotherapy. Among the patients with pancreatic iron overload (IO) at the baseline MRI, only the 5.2% showed no pancreatic IO at the follow-up MRI, performed 18 months later. The 29.5% of patients without baseline pancreatic IO, showed pancreatic IO at the follow-up MRI. The reduction in pancreatic IO was inversely correlated with baseline pancreatic iron levels and directly correlated with reduction in serum ferritin levels and hepatic iron. Among the patients with pancreatic IO at baseline, in all three groups of patients treated with iron chelators in monotherapy (deferrioxamine or deferiprone or deferasirox) there was a significant increase in global pancreas T2* values. The reduction in pancreatic iron levels was comparable among the three groups. Our data showed that it is difficult to remove the iron from the pancreas and that the three iron chelators in monotherapy have a comparable efficacy.