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A prognostic score with pretransplant serum ferritin and disease status predicts outcome following reduced-intensity SCT

Bone Marrow Transplantation volume 47, pages 596–597 (2012)Cite this article

Pretransplant iron overload is one of the important predictors for outcome of allo-hematopoietic SCT (allo-HSCT).1, 2, 3 Recent studies have demonstrated the prognostic impact of elevated serum ferritin on survival and complications following reduced-intensity SCT (RIST).3, 4, 5, 6 We previously reported a simple scoring system that consisted of serum ferritin and disease status at transplantation for predicting outcome in patients with AML and myelodysplastic syndrome (MDS).7 In this report, we studied the applicability of the prognostic score to patients who received RIST in our center.

We evaluated the outcome of consecutive 47 patients with acute leukemia or MDS who underwent RIST at Kanagawa Cancer Center between October 2005 and December 2010. Patient characteristics are summarized in Table 1. A reduced-intensity conditioning regimen was used in patients who were not eligible for a myeloablative regimen because of age >55 years and/or preexisting organ dysfunction. The regimen consisted of fludarabine (25 mg/m2/day for 5 days) and melphalan (70 mg/m2/day for 2 days). Low-dose TBI (4 Gy in two fractions) was added in patients undergoing allo-HSCT from unrelated donors or HLA-mismatched related donors. For the prevention of GVHD, patients received CsA (3 mg/kg, continuous intravenous infusion) or tacrolimus (0.03 mg/kg, continuous intravenous infusion) together with short-term MTX, which was given i.v. at a dose of 10 mg/m2 on day 1 and 7 mg/m2 on days 3 and 6. The following variables were investigated as predictors of the outcome: age, sex, pretransplant serum ferritin, disease type, disease status at transplantation (first or second CR and refractory anemia were defined as standard risk, whereas all others were defined as high risk), GVHD prophylaxis, donor type and stem cell source, acute GVHD and chronic GVHD. Pretransplant serum ferritin measured within 2 weeks before starting conditioning regimen was categorized as low (<1000 ng/mL) or high (⩾1000 ng/mL) on the basis of the previous results.7 The log-rank test was used for comparison of Kaplan–Meier curves, and the Cox regression model was employed for multivariate analyses. Data were analyzed as of 31 March 2011. Statistical analyses were performed with R 2.12.2 software (R Development Core Team, Vienna, Austria).

Table 1 Patients’ characteristics
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Figure 1

References

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Authors and Affiliations

  1. Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan

    M Tanaka, T Tachibana, A Numata, H Takasaki, K Matsumoto, A Maruta & H Kanamori

  2. Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Y Ishigatsubo

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  1. M Tanaka
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  2. T Tachibana
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Correspondence to H Kanamori.

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Tanaka, M., Tachibana, T., Numata, A. et al. A prognostic score with pretransplant serum ferritin and disease status predicts outcome following reduced-intensity SCT. Bone Marrow Transplant 47, 596–597 (2012). https://doi.org/10.1038/bmt.2011.122

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