1 5 8 Editorial correspondence The Journal of Pediatrics January 1990

25 months. Serum ferritin levels decreased by 56% to 99%. No toxic effects were observed.

I wish to corroborate the findings described above and report an additional two cases. I treated two noncompliant thalassemic pa- tients with high doses of deferoxamine. Their ages were 28 and 18 years, respectively, at the time of treatment; both had elevated se- rum ferritin levels, and both were receiving multiple medications for cardiac arrhythmias and chronic congestive heart failure. The serum ferritin levels were 3350 ~g/L and 3700 tzg/L, respectively. They were treated according to the following protocol: deferoxa- mine, 10 mg/kg/hr intravenously for 96 hours every 2 weeks, and deferoxamine, 40 mg/kg/day subcutaneously for 12 hours during the interim periods. This particular schedule was chosen to accom- modate the patients' life-style. After nine cycles (18 weeks) of the combined intravenous-subcutaneous therapy, the ferritin levels fell to 750 ~g/L and 600 #g/L, respectively. The patients tolerated the high-dose intravenous deferoxamine therapy without any toxic ef- fects. With such a rapid decline in the ferritin levels, the patients became highly motivated to continue with their regular subcutane-

ous infusions. I agree with Cohen et al. that daily high-dose intravenous defer-

oxamine therapy may be a valuable alternative for the noneompli- ant patient. The patient with large amounts of iron or iron-induced organ dysfunction when chelation therapy is begun would, in my opinion, also benefit from such innovative chelation approaches.

Dominick Sabatino, MD Department of Pediatrics

Director, Division of Pediatric Hematology-Oneology Nassau County Medical Center

East Meadow, NY 11554

Reply To the Editor."

We are pleased to learn of the rapid reduction in iron stores in two patients of Dr. Sabatino who were treated with high-dose in- travenous deferoxamine therapy as well as subcutaneous infusions. Dr. Hannah Tamary and her colleagues from the Beilinson Med- ical Center recently (September 1989) reported similar success at the Congress of the International Society of Haematology (Euro- pean and African Division), in Jerusalem.

The current efforts to develop an effective and safe oral iron che- lating agent raise the possibility of an easier solution to the prob- lem of iron overload. However, an oral drug will probably not be available for regular clinical use in the United States for at least 2 years, and it would be a serious mistake if the expectation of an oral chelator led physicians and patients to reduce or abandon their current efforts to lower iron stores. For patients who have large iron stores, regular intravenous infusions of deferoxamine provide a safe method for rapidly removing excessive iron.

Alan Cohen, MD Elias Schwartz, MD

Division of Hematology Children's Hospital of Philadelphia

Philadelphia, PA 19104

CORRECTION

In the article "Toxic Effects of Atenolol Consumed During Breast Feeding," in the March 1989 issue (pp. 476 to 478) of THE JOURNAL, the correct spellings of the first two authors ' names are as follows: Michael S. Schimmel, MD, and Arthur I. Eidelman, MD.