Korean J Hematol.  2009 Dec;44(4):227-236. 10.5045/kjh.2009.44.4.227.

Influence of Serum Ferritin on Transplant-related Outcomes and Complications in Children Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

• Lee YJ
• Cho HR
• Bae KW
• Park M
• Koh KN
• Song JS
• Im HJ
• Seo JJ

• KMID: 2252101
• DOI: http://doi.org/10.5045/kjh.2009.44.4.227

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 (> or =1,000 microgram/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 hyperferritinemia (> or =1,000 microgram/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 microgram/L). Very high levels (VHL) of ferritin (> or =3,000 microgram/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.

Keyword

Iron overload; Ferritin; Hematopoietic stem cell transplantation; Pediatrics

MeSH Terms

Child
Ferritins
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
Humans
Incidence
Iron
Iron Overload
Mass Screening
Multivariate Analysis
Pediatrics
Prevalence
Retrospective Studies
Stem Cell Transplantation
Transplants
Ferritins
Iron

Figure

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  Fig. 1. Change of serum ferritin level before and after HSCT.

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  Fig. 2. Overall survival (OS) according to serum ferritin level at pre-HSCT.

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  Fig. 3. Overall survival (OS) according to serum ferritin level at 3 months post-HSCT.

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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.

Reference

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