Therapeutic Erythrocytapheresis (TE) versus Phlebotomy (P) in the treatment of Hereditary Hemochromatosis (HH) patients: Preliminary results from an ongoing randomized clinical trial (NCT 00202436)

Abstract

Phlebotomy (P) is currently the standard therapy for HH patients and typically consists of removal of 500 ml whole blood weekly. The target is to reduce the serum ferritin levels to 50 lg/L and /or transferrin saturation bellow 50%. Depending on the initial ferritin levels this requires 20–100 P’s over a period of 6 to 24 month. Thereafter P’s are reduced to 3–6 times a year. More recently TE has become a new therapeutic modality. With TE, up to 1000 ml erythrocytes per procedure can be removed, compared to 250 ml erythrocytes per P. Thus TE potentially offers a more efficient method to remove iron overload with less procedures in a shorter time period. The results from our pilot study, in which six patients treated with TE were compared to a historical control group of six HH patients treated with P, showed a reduction of almost 70% in both the total number of procedures and the duration of treatment in the TE group. Although, the procedure costs compared on the basis of a single TE session were higher, the total costs for the whole treatment period were at least comparable but probably cheaper with the use of TE [1].