Patients with ß-Thalassemia Major (MT) require life-long blood transfusions, which often cause iron overload that, if left untreated, may increase patients' morbidity and mortality. Iron Chelation Treatment (ICT), is based on 8-12 hour infusions of Deferoxamine for 5-7 days/week and/or Deferiprone orally administered. ICT aims to reduce iron overload but low satisfaction and low compliance, lead to potentially negative consequences on treatment effectiveness. OBJECTIVES: To investigate ICT satisfaction in MT patients and explore its relationship with their thinking about stopping medication. METHODS: The Italian-THAlassemia-Cosy-&-Outcomes-Assessment (ITHACA) was a naturalistic multicentre study conducted to evaluate costs, quality of life, compliance and treatment satisfaction in MT patients undergoing ICT. In total 126 MT patients >12 years old completed a 28-item satisfaction instrument consisting of 4 domains (perceived effectiveness, burden, side effects, acceptance. Response continuum ranged from 1 (very dissatisfied) to 5 (very satisfied). RESULTS: The median age was 29.4 years (12.3-48.5), with an equal proportion of males and females. At enrolement, 48.0% were treated with Deferoxamine, 33.6% with Deferiprone and 18.4% with combination treatment. 86.5% of patients had at least one MT-related complication and 13.5% changed treatment regimens at least once during the observational period (11.6 median months). Mean satisfaction scores for ‘acceptance', ‘side effects', ‘burden' and ‘perceived effectiveness' were 3.37, 3.57, 3.87 and 4.29 respectively. Simple linear regression analysis showed that satisfaction with ‘acceptance' (R2=11%), ‘burden' (R2=13%) and ‘side effects' (R2=12.3%) are significantly and positively associated with the adherence item ‘never thinking about stopping medication' (p<0.0001 in both cases). CONCLUSIONS: The level of satisfaction with ‘burden', ‘acceptance' and ‘side effects' in MT patients undergoing ICT can help to predict patient adherence. Strategies able to improve satisfaction with ICT are expected to increase patients' adherence, with potential significant consequences on treatment effectiveness.