title: Transfusion-associated iron overload as an adverse risk factor for transplantation outcome in patients undergoing reduced-intensity stem cell transplantation for myeloid malignancies.
abstract: Transfusion-associated iron overload could be an important risk factor in myeloablative hematopoietic stem cell transplantation. However, few studies have evaluated the effect of iron overload in reduced-intensity stem cell transplantation (RIST). We evaluated 38 patients with myeloid malignancies, 16 with and 22 without iron overload, who received RIST. We used pretransplant serum ferritin as a marker of iron overload. There was a positive correlation between the number of transfused packed red blood cells and pretransplant serum ferritin levels (21.5 units and 1,578.7 microg/l in the iron overload group vs. 12 units and 739.3 microg/l in the iron non-overload group; p <0.01). Engraftment day and chimerism analysis were not affected by iron overload (p = 0.71 and 0.47, respectively). There were no differences in treatment-related mortality (p = 0.94), veno-occlusive disease (p = 0.99), acute and chronic graft versus host disease (p = 0.58 and 0.99, respectively) according to iron overload. There was a significant difference in disease-free and overall survival (35.8 and 27% in the iron overload group vs. 80.6 and 54.6% in the iron non-overload group; p = 0.01 and 0.03, respectively). We conclude that transfusion-associated iron overload is an adverse risk factor in RIST for myeloid malignancies. The clinical outcomes according to iron overload in RIST were different in myeloablative hematopoietic stem cell transplantation. A serial follow-up of serum ferritin level and judicious iron chelation therapy will be needed to manage the side effect of iron overload in RIST and improve transplantation outcomes.
authors.affiliation: Department of Internal Medicine, Kwandong University College of Medicine, Koyang, Korea.
authors.forename: Yu Ri
authors.initials: YR
authors.lastname: Kim
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Kim
authors.forename: June-Won
authors.initials: JW
authors.lastname: Cheong
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Song
authors.forename: Yoo Hong
authors.initials: YH
authors.lastname: Min
mesh_terms: D000293:Adolescent; D000328:Adult; D017707:Erythrocyte Transfusion; D005260:Female; D005293:Ferritins / Q000097:blood*; D019337:Hematologic Neoplasms / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007502:Iron Chelating Agents / Q000627:therapeutic use; D019190:Iron Overload / Q000097:blood* / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D007502:Iron Chelating Agents; D005293:Ferritins