Contributions
Type: Publication Only
Background
Many studies have investigated impacts of serum iron parameters and/or radiological evidence of systemic iron overload on stem cell transplantation in acute leukemia.Some of them aimed to discover if iron overload might have any detrimental effect on the transplantation. On the other hand some other studies were interested in negative prognostic sign of hyperferritinemia irrespective of body iron status. Unfortunately, some of the studies evaluating iron overload in transplant setting did not precisely show the patients with iron overload, mainly due to inadequacy of radiological methods in relatively mild hemosiderosis and ignoring consideration of transferrin saturation along with hyperferritinemia for elimination of non-iron overload etiologies of hyperferritinemia.
Aims
Herein, we aimed to investigate the the effect of serum iron tests and iron overload on transplantation related complications and prognosis in acute leukemia with adequate methodology.
Methods
Patients who undergone allogeneic stem cell transplantation for acute leukemia in Hacettepe University Medical School Department of Hematology were screened retrospectively in order to find cases with serum iron tests within 9 months before transplant. Serum iron (SI), total iron binding capacity (TIBC) and ferritin levels had been measured. Transferrin saturation was calculated by dividing serum iron level to TIBC.
Results
There were 84 patients suitable for inclusion. Important baseline characteristics and rates of the endpoints are presented in Figure 1. When various ferritin plus TS cut-off values presented in Table 1 were investigated for a possible relationship with major transplant results only ferritin>2000 + TS>45% was found to have an association with VOD at borderline significance (p=0.067) (Table 1).
Table 1. The relationship between iron overload and major transplant results
| Ferritin > 2000 and TS > 45% | | |
| Yes | No | |
aGVHD | 2 | 12 | 0.410 |
cGVHD | 3 | 11 | 0.813 |
VOD | 2 | 12 | 0,067 |
OS | 69.6±12.5 | 69.5±7.3 | 0,603 |
DFS | 61.5±13.4 | 62.5±7.2 | 0.729 |
Summary
There are many studies reporting about the impact of iron overload on stem cell transplantation. Unfortunately only ferritin level was used to detect iron overload in these studies. There are many conditions associated with increased serum ferritin level (eg. Inflammation, infection, macrophage activation, liver injury, etc...) Therefore an increased ferritin level should not be considered as iron overload by itself. The laboratory sign of iron overload is ferritin elevation in the presence of an increased transferring saturation.Iron overload was investigated by radiological tests in some studies. Although this method is an optimal one in apparent iron overload, it might miss iron overload in early stages.
There are some studies which investigated the association between iron overload and post-transplant prognosis using an acceptable method to define iron overload. Some of them found a relationship between iron overload and post-transplant survival. On the other hand some others did not. Interestingly the relationship between iron overload and VOD, probably the most expected specific transplant complication in patients with liver injury, was not reported in any of these studies considered to have adequate methodologies for detection of iron overload.
In conclusion, we observed a possible relationship between iron overload and post-transplant venoocclusive disease. We did not confirm other post-transplant complications reported in the literature. It must be noticed that although many studies intended to investigate the relationship between iron status and transplant outcomes, only a few of them really looked for the effect of iron overload.
Keyword(s): Acute leukemia, Bone marrow transplant, Iron overload
Type: Publication Only
Background
Many studies have investigated impacts of serum iron parameters and/or radiological evidence of systemic iron overload on stem cell transplantation in acute leukemia.Some of them aimed to discover if iron overload might have any detrimental effect on the transplantation. On the other hand some other studies were interested in negative prognostic sign of hyperferritinemia irrespective of body iron status. Unfortunately, some of the studies evaluating iron overload in transplant setting did not precisely show the patients with iron overload, mainly due to inadequacy of radiological methods in relatively mild hemosiderosis and ignoring consideration of transferrin saturation along with hyperferritinemia for elimination of non-iron overload etiologies of hyperferritinemia.
Aims
Herein, we aimed to investigate the the effect of serum iron tests and iron overload on transplantation related complications and prognosis in acute leukemia with adequate methodology.
Methods
Patients who undergone allogeneic stem cell transplantation for acute leukemia in Hacettepe University Medical School Department of Hematology were screened retrospectively in order to find cases with serum iron tests within 9 months before transplant. Serum iron (SI), total iron binding capacity (TIBC) and ferritin levels had been measured. Transferrin saturation was calculated by dividing serum iron level to TIBC.
Results
There were 84 patients suitable for inclusion. Important baseline characteristics and rates of the endpoints are presented in Figure 1. When various ferritin plus TS cut-off values presented in Table 1 were investigated for a possible relationship with major transplant results only ferritin>2000 + TS>45% was found to have an association with VOD at borderline significance (p=0.067) (Table 1).
Table 1. The relationship between iron overload and major transplant results
| Ferritin > 2000 and TS > 45% | | |
| Yes | No | |
aGVHD | 2 | 12 | 0.410 |
cGVHD | 3 | 11 | 0.813 |
VOD | 2 | 12 | 0,067 |
OS | 69.6±12.5 | 69.5±7.3 | 0,603 |
DFS | 61.5±13.4 | 62.5±7.2 | 0.729 |
Summary
There are many studies reporting about the impact of iron overload on stem cell transplantation. Unfortunately only ferritin level was used to detect iron overload in these studies. There are many conditions associated with increased serum ferritin level (eg. Inflammation, infection, macrophage activation, liver injury, etc...) Therefore an increased ferritin level should not be considered as iron overload by itself. The laboratory sign of iron overload is ferritin elevation in the presence of an increased transferring saturation.Iron overload was investigated by radiological tests in some studies. Although this method is an optimal one in apparent iron overload, it might miss iron overload in early stages.
There are some studies which investigated the association between iron overload and post-transplant prognosis using an acceptable method to define iron overload. Some of them found a relationship between iron overload and post-transplant survival. On the other hand some others did not. Interestingly the relationship between iron overload and VOD, probably the most expected specific transplant complication in patients with liver injury, was not reported in any of these studies considered to have adequate methodologies for detection of iron overload.
In conclusion, we observed a possible relationship between iron overload and post-transplant venoocclusive disease. We did not confirm other post-transplant complications reported in the literature. It must be noticed that although many studies intended to investigate the relationship between iron status and transplant outcomes, only a few of them really looked for the effect of iron overload.
Keyword(s): Acute leukemia, Bone marrow transplant, Iron overload