Summary:
We studied the iron status of 32 evaluable adult acute myeloid leukaemia (AML) survivors who were entered into the UK Medical Research Council acute myeloid leukaemia (AML) 10 and 12 trials at our institution between 1988 and 1998. Patients were required to have been independent of all blood products for at least 3 years. As a group, the median first serum ferritin level was 1323 μg/l (NR 19–300 μg/l) at a median of 1321 days from the last transfusion confirming the presence of significant iron overload persisting for some years after completion of all therapy and blood products. There was a general trend for the serum ferritin level to fall with time, but the fall was less pronounced in men and carriers of the C282Y mutation. Recipients of autologous stem cell transplantation (SCT) had a higher median first serum ferritin level (3245 μg/l) than patients who received chemotherapy alone (1148 μg/l) or allogeneic SCT (1334 μg/l) because of increased use of transfused blood. Nine of the 10 recipients of autologous SCT underwent venesection. No evidence of end organ damage was seen in any patient. Serial monitoring of serum ferritin and assessment of the C282Y status may be useful in all long-term AML survivors, especially autograft recipients.
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
Feder JN, Gnirke A, Thomas W et al. A novel MHC class I-like gene is mutated in patients with hereditary haemochromatosis. Nat Genet 1996; 13: 399–408.
Townsend A, Drakesmith H . Role of HFE in iron metabolism, hereditary haemochromatosis, anaemia of chronic disease, and secondary iron overload. Lancet 2002; 359: 786–790.
Beutler E . The significance of the 187G (H63D) mutation in hemochromatosis. Am J Hum Genet 1997; 61: 762–764.
Worwood M . Pathogenesis and management of haemochromatosis. Br J Haematol 1999; 105 (Suppl. 1): 16–18.
Porter JB . Practical management of iron overload. Br J Haematol 2001; 115: 239–252.
Worwood M . Serum ferritin. Clin Sci (Lond) 1986; 70: 215–220.
Konijn AM, Hershko C . Ferritin synthesis in inflammation. I. Pathogenesis of impaired iron release. Br J Haematol 1977; 37: 7–16.
Chapman RW, Hussain MA, Gorman A et al. Effect of ascorbic acid deficiency on serum ferritin concentration in patients with beta-thalassaemia major and iron overload. J Clin Pathol 1982; 35: 487–491.
Burnett AK, Goldstone AH, Stevens RM et al. Randomised comparison of addition of autologous bone-marrow transplantation to intensive chemotherapy for acute myeloid leukaemia in first remission: results of MRC AML 10 trial. UK Medical Research Council Adult and Children's Leukaemia Working Parties. Lancet 1998; 351: 700–708.
Gabutti V, Borgna-Pignatti C . Clinical manifestations and therapy of transfusional haemosiderosis. Baillieres Clin Haematol 1994; 7: 919–940.
Hollan SR . Transfusion-associated iron overload. Curr Opin Hematol 1997; 4: 436–441.
McKay PJ, Murphy JA, Cameron S et al. Iron overload and liver dysfunction after allogeneic or autologous bone marrow transplantation. Bone Marrow Transplant 1996; 17: 63–66.
Harrison P, Neilson JR, Marwah SS et al. Role of non-transferrin bound iron in iron overload and liver dysfunction in long term survivors of acute leukaemia and bone marrow transplantation. J Clin Pathol 1996; 49: 853–856.
Lichtman SM, Attivissimo L, Goldman IS et al. Secondary hemochromatosis as a long-term complication of the treatment of hematologic malignancies. Am J Hematol 1999; 61: 262–264.
Dorak MT, Burnett AK, Worwood M . Hemochromatosis gene in leukemia and lymphoma. Leuk Lymphoma 2002; 43: 467–477.
Hannuksela J, Savolainen ER, Koistinen P et al. Prevalence of HFE genotypes, C282Y and H63D, in patients with hematologic disorders. Haematologica 2002; 87: 131–135.
Strasser SI, Kowdley KV, Sale GE et al. Iron overload in bone marrow transplant recipients. Bone Marrow Transplant 1998; 22: 167–173.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Butt, N., Clark, R. Autografting as a risk factor for persisting iron overload in long-term survivors of acute myeloid leukaemia. Bone Marrow Transplant 32, 909–913 (2003). https://doi.org/10.1038/sj.bmt.1704244
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1704244
Keywords
This article is cited by
-
Prevalence and risk factors of iron overload after hematopoietic stem cell transplantation for childhood acute leukemia: a LEA study
Bone Marrow Transplantation (2017)
-
Efficacy and safety of deferasirox in non-thalassemic patients with elevated ferritin levels after allogeneic hematopoietic stem cell transplantation
Bone Marrow Transplantation (2016)
-
The management of iron overload in allogeneic hematopoietic stem cell transplant (alloHSCT) recipients: Where do we stand?
Annals of Hematology (2013)
-
The transplant iron score as a predictor of stem cell transplant survival
Journal of Hematology & Oncology (2009)
-
Iron overload in hematopoietic cell transplantation
Bone Marrow Transplantation (2008)