Previous to Desferal, individuals with thalassemia could only
expect to live into their late teens and early 20's, eventually
succumbing to iron overload. Since the iron-removing Desferal
was only introduced in the mid-70's, we are still watching the
life span of adults with thalassemia. Our oldest patient is in
her early 40's. The life expectancy of children who have used
Desferal since a very young age remains to be seen, though
researchers and physicians expect to see long, productive lives.
In affluent countries, a child who is born with thalassemia
major (either beta thalassemia or alpha thalassemia) will face a
lifetime of monthly blood transfusions and nightly infusions of
desferoxamine. Over the past several decades with the progress
of medical technology,this once universally fatal disease has
been converted to a chronic illness. Now a fortunate few have
the opportunity of cure through bone marrow transplantation.
Generally speaking, the younger the recipient, the more
optimistic the outcome. The Lucarelli Staging System is based on
the amount of liver damage sustained as a consequence of iron
overload from chronic transfusion therapy and the adequacy of
Desferal chelation therapy. The staging includes evaluations of
liver size, the schedule and compliance of desferrioxamine
therapy, and liver biopsy (in children over 3 years) to
determine whether or not there has been microscopic liver
damage. Only a precious few children who have this complex
disease will be cured by a bone marrow transplant. The rest of
these children need continued support and acceptance that they
may live normal healthy lives in spite of their illness.