title: Does iron overload really matter in stem cell transplantation?
abstract: A growing body of evidence suggests that iron overload is associated with inferior outcomes after myeloablative allogeneic hematopoietic stem cell transplantation (HSCT). However, all of those studies used surrogate markers of iron overload, especially serum ferritin, and most had a retrospective design. We conducted a prospective observational study in patients with myelodysplastic syndrome or acute leukemia undergoing myeloablative HSCT. Forty-five patients who were followed for over 1 year, with serial measurements of serum iron parameters, as well as liver and cardiac magnetic resonance imaging. There was no significant increase in ferritin, liver or cardiac iron content in the 12 months following HSCT. Although serum ferritin still appeared to have prognostic significance, as previously reported, pre-HSCT iron overload (as reflected in liver iron content) was not associated with increased mortality, relapse, or graft-versus-host disease. These results raise the possibility that the adverse prognostic impact of pre-HSCT hyperferritinemia may be related to factors independent of iron overload.
authors.affiliation: Departments of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA. parmand@partners.org
authors.forename: Philippe
authors.initials: P
authors.lastname: Armand
authors.forename: Marie-Michele
authors.initials: MM
authors.lastname: Sainvil
authors.forename: Haesook T
authors.initials: HT
authors.lastname: Kim
authors.forename: Joanna
authors.initials: J
authors.lastname: Rhodes
authors.forename: Corey
authors.initials: C
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: Ellis J
authors.initials: EJ
authors.lastname: Neufeld
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Kwong
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Soiffer
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D005260:Female; D005293:Ferritins / Q000032:analysis; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007501:Iron / Q000032:analysis; D019190:Iron Overload / Q000150:complications*; D053208:Kaplan-Meier Estimate; D007938:Leukemia / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D008099:Liver / Q000737:chemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D009206:Myocardium / Q000737:chemistry; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D033581:Stem Cell Transplantation; D065227:Transfusion Reaction; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019653:Myeloablative Agonists; D005293:Ferritins; D007501:Iron