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Abstract
Background
Iron overload, primarily related to RBC transfusions, is a relatively common complication in hematopoietic stem cell transplant (HSCT) recipients. There are emerging data from retrospective studies that iron overload can significantly increase the risk of nonrelapse mortality after allogeneic HSCT.
Methods
One hundred and five children who received allogeneic HSCT between Jan 2004 and Feb 2009 at Asan Medical Center were analyzed. For indirect estimation of body iron stores, we measured serum ferritin serially in HSCT recipients at pre-transplant, 3 months and 1 year post-transplant. We also analyzed prevalence of hyperferritinemia, correlation of iron overload and transplant-related outcomes and complications.
Results
The prevalence of hyperferritinemia (≥1,000 μg/L) at pre-HSCT, 3 months and 1 year post-HSCT were 66.7% (70/105), 78% (71/91) and 40.9% (27/66), respectively. Children with hyper-ferritinemia (≥1,000 μg/L) at 3 months post-HSCT had worse 2-year OS (79% vs 95%; P=0.023) than those in the low ferritin group (＜1,000 μg/L). Very high levels (VHL) of ferritin (≥3,000 μg/L) at 3 months post-HSCT were associated with increased incidence of treatment related mortality (23% vs 2%, P=0.001) and acute graft-versus-host disease (54% vs 26%, P=0.007) in univariate analysis. VHL of ferritin remained significant in multivariate analysis.
Conclusion
Hyperferritinemia at 3 months post-HSCT had adverse impact for transplantation outcome in patients undergoing allogeneic stem cell transplantation. These results suggest that the screening and adequate treatment of iron overload in HSCT recipients might be helpful to improve the HSCT outcomes.
References
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Fig. 4.
Cumulative incidence of treatment related mortality (A) and acute graft-versus-host disease (B) according to serum ferritin level at 3 months post-HSCT.
Table 1.
Clinical characteristics of 105 pediatric allogeneic HSCT recipients
Abbreviations: AML, indicates acute myeloblastic leukemia; ALL, acute lymphoblastic leukemia; MDS, myelodysplastic syndrome; ABL, acute biphenotypic leukemia; CML, chronic myeloblastic leukemia; HLH, hemophagoctic lymphohistiocytosis; VOD, venoocclusive disease; aGVHD, acute graft-versus-host-disease; cGVHD, chronic graft-versus-host disease.
Table 2.
Number of packed red cell transfusions by serum ferritin level
| Serum ferritin | |||
|---|---|---|---|
| Low (＜1,000 μg/L) | High (≥1,000 μg/L | P-value | |
| Pre-HSCT | 6.7±4.3 | 16.8±13.3 | ＜0.005 |
| 3 months post-HSCT | 3.1±1.8 | 6.0±5.4 | 0.021 |
| 1 year post-HSCT | 3.9±3.1 | 9.9±9.0 | ＜0.005 |
Table 3.
Clinical characteristics of pediatric allogeneic HSCT recipients according to serum ferritin level at pre-HSCT and 3 months, 1 year post-HSCT
Table 4.
Complications after HSCT according to serum ferritin level
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