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Transplant Toxicities

Prevalence and risk factors of iron overload after hematopoietic stem cell transplantation for childhood acute leukemia: a LEA study

Abstract

Data on post-transplant iron overload (IO) are scarce in pediatrics. We conducted a prospective multicenter cohort study (Leucémie de l’Enfant et de l’Adolescent cohort) to determine the prevalence and risk factors of IO in 384 acute leukemia survivors transplanted during childhood. Prevalence of IO (ferritin level 350 ng/mL) was 42.2% (95%CI 37.2–47.2%). Factors significantly associated with IO were: 1) in univariate analysis: older age at transplant (P<0.001), allogeneic versus autologous transplantation (P<0.001), radiation-based preparative regimen (P=0.035) and recent period of transplantation (P<0.001); 2) in multivariate analysis: older age at transplant in quartiles (Odds Ratio (OR)=7.64, 95% CI: 3.73–15.64 for age >12.7 years and OR=5.36, 95% CI: 2.63–10.95 for age from 8.2 to 12.7 years compared to age < 4.7 years), acute myeloid leukemia (OR=3.23, 95% CI: 1.47–7.13), allogeneic graft (OR=4.34, 95% CI: 2.07–9.12 for alternative donors and OR=2.53, 95% CI: 1.2–5.33 for siblings, compared to autologous graft) and radiation-based conditioning regimen (OR=2.45, 95% CI: 1.09–5.53). Graft-versus-host disease was an additional risk factor for allogeneic graft recipients. In conclusion, IO is a frequent complication in pediatric long-term survivors after transplantation for acute leukemia, more frequently observed in older children, those transplanted from alternative donors or with graft-versus-host disease.

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Acknowledgements

The authors would like to thank the LEA Study Group for the data management and Valérie Macioce for revising the manuscript. The study was supported by the French National Cancer Institute (INCa), the French National Research Agency (ANR), the Cancéropôle PACA, the Regional Council PACA, the Hérault Departmental Comity of the Ligue contre le Cancer and the French Institute for Public Health Research (IRESP).

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Correspondence to A Sirvent.

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Sirvent, A., Auquier, P., Oudin, C. et al. Prevalence and risk factors of iron overload after hematopoietic stem cell transplantation for childhood acute leukemia: a LEA study. Bone Marrow Transplant 52, 80–87 (2017). https://doi.org/10.1038/bmt.2016.205

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