EFFECT OF AGE AT THE START OF IRON CHELATION-THERAPY ON GONADAL-FUNCTION IN BETA-THALASSEMIA MAJOR

Patients with transfusion-dependent thalassemia major tend to have abnormal growth and sexual maturation at puberty, presumably as a result of pituitary iron overload. This study was designed to determine whether chelation therapy with deferoxamine before the age of puberty would ameliorate this problem. We examined 40 patients over 14 years of age with transfusion-dependent thalassemia major. The 19 patients in group A (mean [±SD] age at study, 17.0±1.5 years) had begun nightly treatment with subcutaneous deferoxamine before the age of 10 (mean age at start of treatment, 7.5±1.8 years). The 21 patients in group B (mean age, 24.1±3.8 years) had begun treatment after the age of 10 (mean age at start of treatment, 14.4±4.7 years). The abnormal findings were essentially confined to sexual development. The final height did not differ between groups or from the mean parental height in each group. Ninety percent of the patients in group A had normal sexual development, as compared with 38 percent of those in group B (P = 0.001). Outcomes were correlated with indexes of iron overload; the patients in group A had lower serum ferritin levels before chelation treatment (P = 0.01) and lower average serum ferritin levels during treatment (P = 0.005). Beginning chelation treatment with deferoxamine before the age of puberty can help children with transfusion-dependent thalassemia major to attain normal sexual maturation. AS the survival of patients with thalassemia major has improved, extending into the third and fourth decades of life,1 2 3 growth, sexual development, and fertility have become important issues to be addressed. With the introduction of transfusion programs in which hemoglobin levels are maintained above 6.52 mmol per liter (10.5 g per deciliter), prepubertal linear growth has approached normal rates,4 5 6 but abnormal adolescent growth is still observed in the majority of patients.6,7 Before the use of chelation therapy, the incidence of normal pubertal development was low,8 9 10 with the delay in development attributed to hypogonadism as a result of pituitary iron overload… © 1990, Massachusetts Medical Society. All rights reserved.