title: Non transferrin bound iron (NTBI) in acute leukemias throughout conventional intensive chemotherapy: kinetics of its appearance and potential predictive role in infectious complications.
abstract: We analyzed appearance of non transferrin bound iron (NTBI) in 30 transplant eligible patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) during conventional chemotherapy treatment program and evaluated possible relationship with transfusional body iron intake, iron parameters and clinical complications. For each course, serum samples for NTBI detection were taken prior to chemotherapy, during treatment and during subsequent bone marrow myelosuppression: NTBI was assessed by HPLC. Appearance of NTBI was observed from the start of induction treatment and was still detectable during bone marrow myelosuppression; the recovery of the bone marrow function coincided with the disappearance of NTBI. This kinetic was observed in all subsequent high doses chemotherapy courses, independently from confounding variables such as transfusional iron intake and transferrin saturation. NTBI seems to be a consequence of chemotherapy induced lysis of bone marrow cells and, partly, of hepatocytes after cytotoxic injury. The subsequent persistence of NTBI throughout bone marrow myelosuppression is related to the transient suspension of erythropoietic activity. Moreover, NTBI levels >2μM at the beginning of iatrogenic myelosuppression were associated with higher risk of sepsis caused by Gram negative Bacilli (RR 2.571), also compared with other infectious complications (RR 1.954).
authors.affiliation: Department of Haematology, Ospedale San Gerardo, University of Milano Bicocca, Via Pergolesi 33, 20900 Monza, Italy. Electronic address: ange.belotti@gmail.com.
authors.forename: Angelo
authors.initials: A
authors.lastname: Belotti
authors.affiliation: Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS, University of Milan, Via F. Sforza 35, 20122 Milano, Italy. Electronic address: lorena.duca@guest.unimi.it.
authors.forename: Lorena
authors.initials: L
authors.lastname: Duca
authors.affiliation: Department of Haematology, Ospedale San Gerardo, University of Milano Bicocca, Via Pergolesi 33, 20900 Monza, Italy. Electronic address: l.borin@hsgerardo.org.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Borin
authors.affiliation: Department of Haematology, Ospedale San Gerardo, University of Milano Bicocca, Via Pergolesi 33, 20900 Monza, Italy. Electronic address: silvia.realini@hotmail.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Realini
authors.affiliation: Department of Haematology, Ospedale San Gerardo, University of Milano Bicocca, Via Pergolesi 33, 20900 Monza, Italy. Electronic address: rossella.renso@gmail.com.
authors.forename: Rossella
authors.initials: R
authors.lastname: Renso
authors.affiliation: Department of Haematology, Ospedale San Gerardo, University of Milano Bicocca, Via Pergolesi 33, 20900 Monza, Italy. Electronic address: m.parma@hsgerardo.org.
authors.forename: Matteo
authors.initials: M
authors.lastname: Parma
authors.affiliation: Department of Haematology, Ospedale San Gerardo, University of Milano Bicocca, Via Pergolesi 33, 20900 Monza, Italy. Electronic address: p.pioltelli@hsgerardo.org.
authors.forename: Pietro
authors.initials: P
authors.lastname: Pioltelli
authors.affiliation: Department of Haematology, Ospedale San Gerardo, University of Milano Bicocca, Via Pergolesi 33, 20900 Monza, Italy. Electronic address: enrico.pogliani@unimib.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Pogliani
authors.affiliation: Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS, University of Milan, Via F. Sforza 35, 20122 Milano, Italy. Electronic address: maria.cappellini@unimi.it.
authors.forename: Maria Domenica
authors.initials: MD
authors.lastname: Cappellini
mesh_terms: D000328:Adult; D000368:Aged; D001854:Bone Marrow Cells / Q000378:metabolism / Q000473:pathology; D004920:Erythropoiesis / Q000187:drug effects; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000097:blood / Q000209:etiology / Q000473:pathology; D022781:Hepatocytes / Q000378:metabolism / Q000473:pathology; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000097:blood*; D015470:Leukemia, Myeloid, Acute / Q000097:blood* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood* / Q000188:drug therapy / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000209:etiology / Q000473:pathology; D014168:Transferrin
chemical_list: D014168:Transferrin; D007501:Iron
keywords: Acute leukemia; Chemotherapy; NTBI; Non transferrin bound iron; Transfusional iron overload