Iron overload, hematopoietic cell transplantation, and graft-versus-host disease.
Many patients who undergo hematopoietic cell transplantation (HCT) present with anemia and have received red blood cell transfusions before HCT. As a result, iron overload is frequent and appears to be particularly prominent in patients with myelodysplastic syndromes. There is evidence that peritransplant events contribute to further iron accumulation, although the mechanism that disrupts normal iron homeostasis remains to be determined. Recent studies suggest that iron overload, as determined by ferritin levels, a surrogate marker for iron, is a risk factor for increased non-relapse mortality after HCT. Iron overload is associated with an increased rate of infections, in particular with fungal organisms. Furthermore anecdotal data suggest that increased hepatic iron may mimic the clinical picture of (chronic) graft-versus-host-disease (GVHD). Whether excess iron contributes to GVHD and whether iron depletion, be it by phlebotomy or chelation, reduces the post-transplantation complication rate and improves transplant outcome is yet to be determined.
Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA. jdeeg@fhcrc.org
H Joachim
HJ
Deeg
Emily
E
Spaulding
Howard M
HM
Shulman
D000740:Anemia / Q000209:etiology / Q000628:therapy; D000818:Animals; D017209:Apoptosis; D015913:Chelation Therapy; D003937:Diagnosis, Differential; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007239:Infections / Q000209:etiology; D007408:Intestinal Absorption; D019190:Iron Overload / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D019266:Iron, Dietary / Q000493:pharmacokinetics; D008099:Liver / Q000378:metabolism / Q000473:pathology; D051379:Mice; D008815:Mice, Inbred Strains; D016513:Mice, SCID; D009190:Myelodysplastic Syndromes / Q000097:blood / Q000150:complications / Q000601:surgery; D018962:Phlebotomy; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D014168:Transferrin / Q000378:metabolism / Q000627:therapeutic use; D019172:Transplantation Conditioning / Q000009:adverse effects
D019266:Iron, Dietary; D014168:Transferrin