title: The Impact of Pre-Stem Cell Transplant Ferritin Level on Late Transplant Complications: An Analysis to Determine the Potential Role of Iron Overload on Late Transplant Outcomes.
abstract: BACKGROUND
  Iron overload has been associated with increased non-relapse mortality (NRM) in patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) undergoing hematopoietic stem cell transplantation (HSCT). Elevated ferritin level pre-HSCT has been used as a marker for iron overload. It is unclear whether the negative effect of iron overload as measured by elevated ferritin level extends beyond the first three months post HSCT, as this would suggest a potential role for active management of iron overload post HSCT.
  
  
  METHODS
  Sixty-three patients with AML and MDS who underwent an allogeneic HSCT from a sibling or unrelated donor between January to December 2006, had a pre-HSCT ferritin level and were alive and disease free 90 days post HSCT.
  
  
  RESULTS
  Median age was 51. Patients with the lowest pre-HSCT ferritin level (Q1) had a trend towards improved overall survival and progression free survival when compared to patients with higher level (Q2-Q4) (P=0.06, and 0.125). Cumulative incidence of NRM at 2 years was 20 and 30% respectively (P=0.4).
  
  
  CONCLUSIONS
  Pre-HSCT ferritin level may still have an impact on HSCT events beyond 3 months post transplant, suggesting a role for research into active management of iron overload with either phlebotomy or chelation.
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapies, University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Yvonne A
authors.initials: YA
authors.lastname: Efebera
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapies, University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Rupinderjit S
authors.initials: RS
authors.lastname: Thandi
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapies, University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Rima M
authors.initials: RM
authors.lastname: Saliba
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapies, University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Uday
authors.initials: U
authors.lastname: Popat
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapies, University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Marcos
authors.initials: M
authors.lastname: De Lima
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapies, University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Amin
authors.initials: A
authors.lastname: Alousi
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapies, University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapies, University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rondon
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapies, University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Richard
authors.initials: R
authors.lastname: Champlin
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapies, University of Texas M.D. Anderson Cancer Center, Houston, TX.
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
keywords: AML; Ferritin; Hematopoietic Stem Cell Transplant; Late Transplant Outcome; MDS