Iron overload in allogeneic hematopoietic cell transplantation outcome: a meta-analysis.
An elevated ferritin level before allogeneic hematopoietic cell transplantation (HCT) is an adverse prognostic factor for overall survival (OS) and nonrelapse mortality. Because ferritin is an imperfect surrogate of iron stores, the prognostic role of iron overload remains unclear. We conducted a patient-level meta-analysis of 4 studies that used magnetic resonance imaging to estimate pre-HCT liver iron content (LIC). An elevated LIC was not associated with a significant increase in mortality: the hazard ratio (HR) for mortality associated with LIC > 7 mg/g dry weight (primary endpoint) was 1.4 (P = .18). In contrast, ferritin >1000 ng/mL was a significant prognostic factor (HR for mortality, 1.7; P = .036). There was, however, no significant association between ferritin > 2500 and mortality. This meta-analysis suggests that iron overload, as assessed by LIC, is not a strong prognostic factor for OS in a general adult HCT population. Our data also suggest that ferritin is an inadequate surrogate for iron overload in HCT.
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. Electronic address: parmand@partners.org.
Philippe
P
Armand
Department Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Haesook T
HT
Kim
Department of Radiology, Turku University Hospital, Turku, Finland.
Johanna M
JM
Virtanen
Department of Radiology, Turku University Hospital, Turku, Finland.
Riitta K
RK
Parkkola
Department of Medicine, Turku University Hospital, Turku, Finland.
Maija A
MA
Itälä-Remes
Department of Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
Navneet S
NS
Majhail
Department of Medicine, Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
Linda J
LJ
Burns
Biostatistics Core, Masonic Cancer Center, University of Minnesota Medical School, Minneapolis, Minnesota.
Todd
T
DeFor
Department of Medicine, Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
Bryan
B
Trottier
Department of Medicine I, University Hospital C.-G.-Carus, Dresden, Germany.
Uwe
U
Platzbecker
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Joseph H
JH
Antin
Department of Medicine I, University Hospital C.-G.-Carus, Dresden, Germany.
Martin
M
Wermke
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005293:Ferritins / Q000097:blood*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007501:Iron / Q000032:analysis; D019190:Iron Overload / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult
D005293:Ferritins; D007501:Iron
Allogeneic hematopoietic cell transplantation; Iron overload; Serum ferritin