Update on toxicity and efficacy aspects of treatment with deferasirox and its implication on the morbidity and mortality of transfused iron loaded patients.

There are major concerns regarding the toxicity, efficacy and costs of deferasirox in transfused iron loaded patients. Marketing policies resulted in its indiscriminate use and have overtaken safety issues. Renal, hepatic and pancytopenia fatal episodes have been reported. However, despite these fatalities it would appear that there is no regular monitoring of such toxicities or of effects such as the accumulation of toxic metals. The safety of some patients can also be compromised by the low efficacy of deferasirox in the removal of excess iron, especially from the heart, which in the long term can also result in an overall increase in morbidity and mortality. Safer, less costly and more effective treatments are available by using deferoxamine, deferiprone and their combination.