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Prognostic impact of pretransplantation hyperferritinemia in adults undergoing allogeneic hematopoietic SCT: a meta-analysis

Bone Marrow Transplantation volume 49, pages 1339–1340 (2014)Cite this article

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Serum ferritin (SF) is a muti-functional protein, which is involved in cell proliferation, angiogenesis, immunosuppression and iron delivery.1 The elevation of SF is associated with iron overload and inflammation.2 Therefore, patients who undergo hematopoietic SCT (HSCT), a curative treatment for malignant and nonmalignant hematologic diseases, are at risk for excess accumulation of SF due to red blood cell transfusions and recent infection.3,4 Although emerging evidence suggests that there is a strong link between hyperferritinemia (HF) and inferior OS in patients receiving HSCT, the precise magnitude of the association remains uncertain, and it is not clear whether the HF is as an independent prognostic factor or simply reflects iron overload or acute-phase reactants. To comprehensively assess the prognostic significance of pretransplantation HF, we performed herein a meta-analysis.

All studies that investigated the association between pretransplantation HF and clinical outcomes in adults undergoing allogeneic HSCT published to date and included in the PubMed, EMBASE and Web of SCIENCE were considered. Information retrieved from the researches included author, publication year, study location, number of subjects, underlying disease, median follow-up, age range, conditioning regimen (myeloablative or reduced-intensity), cutoff value of HF, detection time before HSCT, covariates adjusted for HF and hazard ratio (HR) with 95% confidence intervals (CIs) for clinical outcomes (non-relapse mortality (NRM) and OS). To quantify the predictive ability of pretransplantation HF on clinical outcomes after HSCT, the HRs and their 95% CIs of NRM and OS were extracted from original articles. Heterogeneity test was assessed with I2 statistics and Q test.5 When the heterogeneity was high (P<0.05 or I2>50%), a random-effects model was used; otherwise, a fixed-effects model was applied. By convention, HR>1 indicates that the patients with pretransplantation HF are associated with a worse outcome or a higher risk as compared to those without the HF. Only when the 95% CIs did not overlap with 1, were the results statistically significant. The statistical calculations for this meta-analysis were performed with Stata Statistical Software Version 12.0 (StataCorp LP, College Station, TX, USA), with P-values of <0.05 considered statistically significant.

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References

  1. Alkhateeb AA, Connor JR The significance of ferritin in cancer: Anti-oxidation, inflammation and tumorigenesis. Biochim Biophys Acta 2013; 1836: 245–254.

    CAS  PubMed  Google Scholar 

  2. Tachibana T, Tanaka M, Numata A, Takasaki H, Ito S, Ohshima R et al. Pretransplant serum ferritin has a prognostic influence on allogeneic transplant regardless of disease risk. Leuk Lymphoma 2012; 53: 456–461.

    Article  CAS  Google Scholar 

  3. Storey JA, Connor RF, Lewis ZT, Hurd D, Pomper G, Keung YK et al. The transplant iron score as a predictor of stem cell transplant survival. J Hematol Oncol 2009; 2: 44.

    Article  Google Scholar 

  4. Ozyilmaz E, Aydogdu M, Sucak G, Aki SZ, Ozkurt ZN, Yegin ZA et al. Risk factors for fungal pulmonary infections in hematopoietic stem cell transplantation recipients: the role of iron overload. Bone Marrow Transplant 2010; 45: 1528–1533.

    Article  CAS  Google Scholar 

  5. Yusuf S, Peto R, Lewis J, Collins R, Sleight P Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985; 27: 335–371.

    Article  CAS  Google Scholar 

  6. Tanaka M, Tachibana T, Numata A, Takasaki H, Matsumoto K, Maruta A et al. A prognostic score with pretransplant serum ferritin and disease status predicts outcome following reduced-intensity SCT. Bone Marrow Transplant 2012; 47: 596–597.

    Article  CAS  Google Scholar 

  7. Tachibana T, Takasaki H, Tanaka M, Maruta A, Hyo R, Ishigatsubo Y et al. Serum ferritin and disease status at transplantation predict the outcome of allo-SCT in patients with AML or myelodysplastic syndrome. Bone Marrow Transplant 2011; 46: 150–151.

    Article  CAS  Google Scholar 

  8. Armand P Hyperferritinemia in stem cell transplantation. Biol Blood Marrow Transplant 2013; 19: 335–337.

    Article  Google Scholar 

  9. Sivgin S, Baldane S, Akyol G, Keklik M, Kaynar L, Kurnaz F et al. The oral iron chelator deferasirox might improve survival in allogeneic hematopoietic cell transplant (alloHSCT) recipients with transfusional iron overload. Transfusion Apheresis Sci 2013; 49: 295–301.

    Article  Google Scholar 

  10. Lee JW, Kang HJ, Kim EK, Kim H, Shin HY, Ahn HS Effect of iron overload and iron-chelating therapy on allogeneic hematopoietic SCT in children. Bone Marrow Transplant 2009; 44: 793–797.

    Article  CAS  Google Scholar 

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Acknowledgements

This study was supported in part by Grants from the National Natural Science Foundation of China (No.: 30971283, No.: 81170502), the Zhejiang Provincial Natural Science Foundation of China (No.: LZ12H08001), the Creative Team Project of Zhejiang Provincial Bureau of Science and Technology (No.: 2011R50015) and Zhejiang Provincial Fund of Health Bureau (No.: 2007B122).

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  1. Z Wang and M Jia: These authors contributed equally to this work.

Authors and Affiliations

  1. Division of Hematology-oncology, Children’s Hospital of Zhejiang University School of Medicine, Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, PR China

    Z Wang, M Jia, H Zhao, Y Cheng, Z Luo, Y Chen, X Xu & Y Tang

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  1. Z Wang
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  2. M Jia
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Correspondence to Y Tang.

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Wang, Z., Jia, M., Zhao, H. et al. Prognostic impact of pretransplantation hyperferritinemia in adults undergoing allogeneic hematopoietic SCT: a meta-analysis. Bone Marrow Transplant 49, 1339–1340 (2014). https://doi.org/10.1038/bmt.2014.127

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