The prospect for transfusion-dependent patients to receive effective iron chelation therapy has substantially improved in the last few years. Subcutaneous DFO 40 mg/kg over 8-12 hours on at least 5 days a week protects most compliant patients against cardiac disease and other serious complications and remains the first choice. Its cost, frequent lack of compliance, and complications means that alternative approaches are needed. After many years of short-term clinical trials of the orally active agent deferiprone and much controversy about its efficacy and toxicity, recent published data have been favorable on both aspects. These suggest that the drug at a dose of 75 mg/kg/d may be at least as effective as DFO in protecting patients from iron-induced cardiomyopathy. Hepatic fibrosis does not appear to be a problem, and the established side effects do not lead to the need for discontinuation of the drug in the majority of patients.