title: Prognostic impact of pretransplant iron overload measured with magnetic resonance imaging on severe infections in allogeneic stem cell transplantation.
abstract: OBJECTIVE
  Infections and graft-versus-host disease (GVHD) are the main causes of transplant-related mortality (TRM) of patients undergoing allo-SCT. The role of iron overload (IO) has been debated in this context. Studies, performed with non-specific surrogate markers of iron, suggest that IO predicts poor outcome after allo-SCT.
  
  
  METHODS
  In this prospective study, we quantified pretransplant IO with MRI-based hepatic iron concentration (HIC) measurement; the degree of IO was used to predict infections, GVHD, and mortality after allo-SCT. Logistic univariate, multivariate, and Cox's regression analyses were performed.
  
  
  RESULTS
  Iron overload was present in 78% of the patients (HIC>36 μmol/g). The median HIC was 98 μmol/g (range 5-348). There were no cases of cardiac iron excess. IO was significantly associated with severe infections during the early post-transplant period (for every 10 μmol/g increase OR: 1.15, 95% CI 1.05-1.26, P = 0.003). The odds for severe infections increased 6.5- (>125 μmol/g OR: 6.5, P = 0.013) to 14-fold (>269 μmol/g OR: 14.1, P = 0.040) with increasing HIC. IO was found to be associated with reduced risk of acute and chronic GVHD. Although TRM was due to infection-related deaths, IO was not associated with TRM or OS.
  
  
  CONCLUSIONS
  Pretransplant IO, measured with a direct MRI-based measurement, predicts severe infections in the early post-transplant period.
authors.affiliation: Department of Radiology, Medical Imaging Centre of Southwest Finland, University of Turku and Turku University Hospital, Turku, Finland. johanna.virtanen@tyks.fi
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Virtanen
authors.forename: Maija A
authors.initials: MA
authors.lastname: Itälä-Remes
authors.forename: Kari J
authors.initials: KJ
authors.lastname: Remes
authors.forename: Tero
authors.initials: T
authors.lastname: Vahlberg
authors.forename: Jani P
authors.initials: JP
authors.lastname: Saunavaara
authors.forename: Marjatta
authors.initials: M
authors.lastname: Sinisalo
authors.forename: Riitta K
authors.initials: RK
authors.lastname: Parkkola
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006086:Graft vs Host Disease; D006801:Humans; D007501:Iron / Q000378:metabolism; D019190:Iron Overload / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D033581:Stem Cell Transplantation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007501:Iron