Abstract
Iron overload is known to increase complications of hematopoietic SCT (HSCT). We investigated the association of pre-transplant ferritin level with complications and survival after allogeneic HSCT, and evaluated the efficacy of iron-chelating therapy before HSCT. We retrospectively reviewed 101 patients who underwent allogeneic HSCT and divided these patients into three groups: F>1000, patients with ferritin level above 1000 ng/ml at the time of HSCT; F<1000, patients whose ferritin levels were maintained below 1000 ng/ml before HSCT without iron-chelating therapy; IC, patients with ferritin level decreased to less than 1000 ng/ml after iron-chelating therapy before HSCT. In the comparison between the F>1000 group and the F<1000 group, hyperbilirubinemia and treatment-related mortality (TRM) were significantly higher in the F>1000 group. The F>1000 group also showed decreased OS and EFS. In the comparison of the F<1000 and IC groups, there was no significant difference in complications and survival. When compared with the F>1000 group, the IC group showed lower TRM and higher survival. Elevated serum ferritin level was associated with increased TRM and decreased survival, and the analysis of the IC group suggested the benefit of iron-chelating therapy to improve the outcome of HSCT.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Dürken M, Nielsen P, Knobel S, Finckh B, Herrnring C, Dresow B et al. Nontransferrin-bound iron in serum of patients receiving bone marrow transplants. Free Radic Bio Med 1997; 22: 1159–1163.
Evens AM, Mehta J, Gordon LI . Rust and corrosion in hematopoietic stem cell transplantation: the problem of iron and oxidative stress. Bone marrow transplant 2004; 34: 561–571.
Morado M, Ojeda E, Garcia-Bustos J, Aguado MJ, Arrieta R, Quevedo E et al. BMT: Serum ferritin as risk factor for veno-occlusive disease of the liver: prospective cohort study. Hematology 2000; 4: 505–512.
Altes A, Remacha AF, Sarda P, Baiget M, Sureda A, Martino R et al. Early clinical impact of iron overload in stem cell transplantation. A prospective study. Ann Hematol 2007; 86: 443–447.
Altes A, Remacha AF, Sarda P, Sancho FJ, Sureda A, Martino R et al. Frequent severe liver iron overload after stem cell transplantation and its possible association with invasive aspergillosis. Bone marrow transplant 2004; 34: 505–509.
Miceli MH, Dong L, Grazziutti ML, Fassas A, Thertulien R, Van Rhee F et al. Iron overload is a major risk factor for severe infection after autologous stem cell transplantation: a study of 367 myeloma patients. Bone marrow transplant 2006; 37: 857–864.
Altes A, Remacha AF, Sureda A, Martino R, Briones J, Canals C et al. Iron overload might increase transplant-related mortality in haematopoietic stem cell transplantation. Bone marrow transplant 2002; 29: 987–989.
Armand P, Kim HT, Cutler CS, Ho VT, Koreth J, Alyea EP et al. Prognostic impact of elevated pretransplantation serum ferritin in patients undergoing myeloablative stem cell transplantation. Blood 2007; 109: 4586–4588.
Jones RJ, Lee KS, Beschorner WE, Vogel VG, Grochow LB, Braine HG et al. Venoocclusive disease of the liver following bone marrow transplantation. Transplantation 1987; 44: 778–783.
Kang HJ, Kho SH, Jang MK, Lee SH, Shin HY, Ahn HS . Early engraftment kinetics of two units cord blood transplantation. Bone marrow transplant 2006; 38: 197–201.
Kang HJ, Shin HY, Choi HS, Ahn HS . Fludarabine, cyclophosphamide plus thymoglobulin conditioning regimen for unrelated bone marrow transplantation in severe aplastic anemia. Bone marrow transplant 2004; 34: 939–943.
Maggio A . Light and shadows in the iron chelation treatment of haematological diseases. Br J haematol 2007; 138: 407–421.
Giardini C, Galimberti M, Lucarelli G, Polchi P, Angelucci E, Baronciani D et al. Desferrioxamine therapy accelerates clearance of iron deposits after bone marrow transplantation for thalassaemia. Br J haematol 1995; 89: 868–873.
Gaziev D, Giardini C, Angelucci E, Polchi P, Galimberti M, Baronciani D et al. Intravenous chelation therapy during transplantation for thalassemia. Haematologica 1995; 80: 300–304.
Ho GT, Parker A, MacKenzie JF, Morris AJ, Stanley AJ . Abnormal liver function tests following bone marrow transplantation: aetiology and role of liver biopsy. Eur J Gastroenterol Hepatol 2004; 16: 157–162.
Acknowledgements
This study was supported by the grants of the Korea Healthcare Technology R&D Project, Ministry of Health, Welfare and Family affairs, Republic of Korea (A070001) and (A080588).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lee, J., Kang, H., Kim, E. et al. Effect of iron overload and iron-chelating therapy on allogeneic hematopoietic SCT in children. Bone Marrow Transplant 44, 793–797 (2009). https://doi.org/10.1038/bmt.2009.88
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/bmt.2009.88
Keywords
This article is cited by
-
Pharmacometabolomics for predicting variable busulfan exposure in paediatric haematopoietic stem cell transplantation patients
Scientific Reports (2017)
-
Impact of pretransplant red cell transfusion on outcome after allogeneic stem cell transplantation in adult patients with severe aplastic anemia
Bone Marrow Transplantation (2016)
-
Efficacy and safety of deferasirox in non-thalassemic patients with elevated ferritin levels after allogeneic hematopoietic stem cell transplantation
Bone Marrow Transplantation (2016)
-
Prognostic impact of pretransplantation hyperferritinemia in adults undergoing allogeneic hematopoietic SCT: a meta-analysis
Bone Marrow Transplantation (2014)
-
Combined use of Chinese medicine with allogeneic hematopoietic stem cell transplantation for severe aplastic anemia patients
Chinese Journal of Integrative Medicine (2014)