title: Elevated pretransplant ferritin is associated with a lower incidence of chronic graft-versus-host disease and inferior survival after myeloablative allogeneic haematopoietic stem cell transplantation.
abstract: Elevated pretransplant serum ferritin levels have been associated with an increased incidence of morbidity and mortality after allogeneic haematopoietic stem cell transplantation (HCT). We studied 222 patients who underwent myeloablative allogeneic HCT in whom pretransplantation serum ferritin levels were available. Pretransplantation ferritin > 1910 microg/l was associated with lower overall survival (P = 0.003), lower relapse-free survival (P = 0.003), decreased chronic graft-versus-host disease (GVHD) (P = 0.019) and increased non-relapse mortality (NRM) (P = 0.042). Similar results were obtained when pretransplantation ferritin was analysed as a continuous variable and by quartiles. Our results indicate that an elevated pretransplant ferritin level adversely impacts transplantation outcomes. The adverse impact of elevated ferritin on NRM and survival was despite its association with lower incidences of acute and chronic GVHD, which are major causes of NRM. The association of ferritin with iron overload and its influence on HCT outcomes requires further prospective validation.
authors.affiliation: Department of Hematologic Oncology and Blood Disorders, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA. mahinda@ccf.org
authors.forename: Anuj
authors.initials: A
authors.lastname: Mahindra
authors.forename: Brian
authors.initials: B
authors.lastname: Bolwell
authors.forename: Ronald
authors.initials: R
authors.lastname: Sobecks
authors.forename: Lisa
authors.initials: L
authors.lastname: Rybicki
authors.forename: Brad
authors.initials: B
authors.lastname: Pohlman
authors.forename: Robert
authors.initials: R
authors.lastname: Dean
authors.forename: Steve
authors.initials: S
authors.lastname: Andresen
authors.forename: John
authors.initials: J
authors.lastname: Sweetenham
authors.forename: Matt
authors.initials: M
authors.lastname: Kalaycio
authors.forename: Edward
authors.initials: E
authors.lastname: Copelan
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D005293:Ferritins / Q000378:metabolism*; D006086:Graft vs Host Disease / Q000097:blood / Q000209:etiology* / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D019190:Iron Overload / Q000097:blood* / Q000401:mortality; D007938:Leukemia / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000097:blood / Q000401:mortality / Q000628:therapy; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D005293:Ferritins