title: Iron overload during follow-up after tandem high-dose chemotherapy and autologous stem cell transplantation in patients with high-risk neuroblastoma.
abstract: Multiple RBC transfusions inevitably lead to a state of iron overload before and after high-dose chemotherapy and autologous stem cell transplantation (HDCT/autoSCT). Nonetheless, iron status during post-SCT follow-up remains unknown. Therefore, we investigated post-SCT ferritin levels, factors contributing to its sustained levels, and organ functions affected by iron overload in 49 children with high-risk neuroblastoma who underwent tandem HDCT/autoSCT. Although serum ferritin levels gradually decreased during post-SCT follow-up, 47.7% of the patients maintained ferritin levels above 1,000 ng/mL at 1 yr after the second HDCT/autoSCT. These patients had higher serum creatinine (0.62 vs 0.47 mg/mL, P = 0.007) than their counterparts (< 1,000 ng/mL). Post-SCT transfusion amount corresponded to increased ferritin levels at 1 yr after the second HDCT/autoSCT (P < 0.001). A lower CD34(+) cell count was associated with a greater need of RBC transfusion, which in turn led to a higher serum ferritin level at 1 yr after HDCT/autoSCT. The number of CD34(+) cells transplanted was an independent factor for ferritin levels at 1 yr after the second HDCT/autoSCT (P = 0.019). Consequently, CD34(+) cells should be transplanted as many as possible to prevent the sustained iron overload after tandem HDCT/autoSCT and consequent adverse effects.
authors.affiliation: Hannover Medical School, Hannover, Germany.
authors.forename: Soo Jin
authors.initials: SJ
authors.lastname: Bae
authors.forename: Christine
authors.initials: C
authors.lastname: Kang
authors.forename: Ki Woong
authors.initials: KW
authors.lastname: Sung
authors.forename: Hee Won
authors.initials: HW
authors.lastname: Chueh
authors.forename: Meong Hi
authors.initials: MH
authors.lastname: Son
authors.forename: Soo Hyun
authors.initials: SH
authors.lastname: Lee
authors.forename: Keon Hee
authors.initials: KH
authors.lastname: Yoo
authors.forename: Hong Hoe
authors.initials: HH
authors.lastname: Koo
mesh_terms: D018952:Antigens, CD34 / Q000378:metabolism; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001565:Benzoates / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D000077588:Deferasirox; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007502:Iron Chelating Agents / Q000627:therapeutic use; D019190:Iron Overload / Q000209:etiology*; D009447:Neuroblastoma / Q000188:drug therapy / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation; D065227:Transfusion Reaction; D014182:Transplantation, Autologous; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D018952:Antigens, CD34; D001565:Benzoates; D007502:Iron Chelating Agents; D014230:Triazoles; D005293:Ferritins; D003404:Creatinine; D000077588:Deferasirox