Tool to Manage Iron Overload in Patients with Myelodysplastic Syndromes

Iron overload has been identified as a common and important issue in the management of patients with myelodysplastic syndromes (MDS). To help clinicians diagnose and manage iron overload in patients with MDS, the Canadian Consortium on MDS (CCMDS) has developed a step-by-step algorithm, called the MDS Iron Road.

The tool is available free online and was presented at the 62nd ASH Annual Meeting & Exposition. Lead author Heather A. Leitch, MD, of St. Paul’s Hospital University of British Columbia in Vancouver, Canada, and colleagues hope the algorithm will help standardize care for patients with MDS and iron overload.

The MDS Iron Road reviews:

  • Iron-reduction strategies, including iron chelation therapy (ICT)
  • Evidence supporting the clinical benefits of ICT
  • Chelators available
  • Dosing, administration, and adjustments
  • Monitoring guidance and expected response
  • Side effect management

Clinicians have two ways to use the tool. A self-directed Iron Road outlines the algorithm. The IR Express mode guides the user through a series of questions about a patient, then makes a treatment recommendation.

The tool offers evidence to support treatment recommendations when available. In areas where evidence was lacking, the consortium offers practical recommendations based on their clinical experience.

During the ASH meeting, the researchers presented a case study to demonstrate how the algorithm works at different decision points. They highlighted research that supports certain decisions, as well as areas where data are lacking that could benefit from future research.

The MDS Iron Road is based on years of work by the consortium. In 2008, the CCMDS published an evidence-based consensus guideline regarding the diagnosis, workup, and management of iron overload in patients with MDS. That guideline discusses cellular damage caused by iron overload, including organ dysfunction, infections, marrow failure, progression of acute myeloid leukemia, decreased survival, and more. Then, in 2013, the consortium released MDS Clear Path, an internet-based algorithm for the diagnosis, workup, and management of MDS. The latest addition to the consortium’s resources is the MDS Iron Road, which refers back to the MDS Clear Path as needed, such as for prognostic scores and details on therapeutic options.

The tool is available online at The username is ironroad, and the password is makeirongreatagain. It is currently in English, with a French version in development.

Although the MDS Iron Road includes treatment options that may not be currently approved in all geographic areas, the researchers said the algorithm will be updated to reflect future approvals and advances.