title: Prognostic impact of elevated pretransplantation serum ferritin in patients undergoing myeloablative stem cell transplantation.
abstract: Iron overload could be a significant contributor to treatment-related mortality (TRM) for patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT). We studied 590 patients who underwent myeloablative allogeneic HSCT at our institution, and on whom a pretransplantation serum ferritin was available. An elevated pretransplantation serum ferritin level was strongly associated with lower overall and disease-free survival. Subgroup multivariable analyses demonstrated that this association was restricted to patients with acute leukemia or myelodysplastic syndrome (MDS); in the latter group, the inferior survival was attributable to a significant increase in TRM. There was also a trend toward an increased risk of veno-occlusive disease in patients with high ferritin. Our results argue that iron overload plays an important role in transplantation outcome for patients with acute leukemia or MDS, as it does in thalassemia. They also suggest future prospective trials to examine the potential benefit of chelation therapy in this setting.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. parmand@partners.org
authors.forename: Philippe
authors.initials: P
authors.lastname: Armand
authors.forename: Haesook T
authors.initials: HT
authors.lastname: Kim
authors.forename: Corey S
authors.initials: CS
authors.lastname: Cutler
authors.forename: Vincent T
authors.initials: VT
authors.lastname: Ho
authors.forename: John
authors.initials: J
authors.lastname: Koreth
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Alyea
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Soiffer
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
mesh_terms: D000418:Albumins / Q000502:physiology; D005293:Ferritins / Q000097:blood*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology; D006801:Humans; D007165:Immunosuppression Therapy / Q000401:mortality; D019190:Iron Overload / Q000209:etiology; D009190:Myelodysplastic Syndromes / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009196:Myeloproliferative Disorders / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012698:Serologic Tests; D016019:Survival Analysis
chemical_list: D000418:Albumins; D005293:Ferritins