title: New insights into transfusion-related iron toxicity: Implications for the oncologist.
abstract: Iron overload is a potentially life-threatening consequence of multiple red-blood-cell transfusions. Here, we review factors affecting excess iron distribution and its damage to specific tissues, as well as mechanisms of oncogenesis by iron. Although consequences of transfusional iron overload are best described in thalassemia major and related inherited anemias, they are increasingly recognized in acquired conditions, such as myelodysplastic syndromes (MDS). Iron overload in MDS not only impacts on certain tissues, but may affect the clonal evolution of MDS through generation of reactive oxygen species. Iron overload may also influence hematopoietic-stem-cell-transplantation outcomes. Novel MRI methods for assessing body iron have impacted significantly on outcome in inherited anemias by allowing monitoring of iron burden and iron chelation therapy. This approach is increasingly being used in MDS and stem-cell-transplant procedures. Knowledge gained from managing transfusional iron overload in inherited anemias may be translated to general oncology, with potential for improved patient outcomes.
authors.affiliation: Department of Haematology, University College London, UCL Cancer Institute, Paul O'Gorman Building, 72 Huntley Street, London WC1E 6BT, UK. Electronic address: j.porter@ucl.ac.uk.
authors.forename: John B
authors.initials: JB
authors.lastname: Porter
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: de Witte
authors.affiliation: Università di Milano, Ca Granda Foundation IRCCS, Milano, Italy.
authors.forename: M Domenica
authors.initials: MD
authors.lastname: Cappellini
authors.affiliation: Heinrich-Heine-Universität, Düsseldorf, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Gattermann
mesh_terms: D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007501:Iron / Q000009:adverse effects*; D007502:Iron Chelating Agents / Q000627:therapeutic use; D019190:Iron Overload / Q000188:drug therapy / Q000209:etiology*; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000188:drug therapy*; D065227:Transfusion Reaction
chemical_list: D007502:Iron Chelating Agents; D007501:Iron
keywords: Acute myeloid leukemia; Chelation; Hematopoietic stem cell transplantation; Iron overload; Myelodysplastic syndromes; Oncogenesis; Thalassemia; Transfusion