title: [Effects of iron chelation therapy on allogeneic hematopoietic stem cell transplantation in myelodysplastic syndrome patients with iron overload].
abstract: OBJECTIVE
  To investigate the effects of iron chelation therapy on hematopoietic reconstitution and related complications of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with myelodysplastic syndrome (MDS).
  
  
  METHODS
  Various clinical parameters were analyzed retrospectively in 57 MDS patients with iron overload who received allo-HSCT. According to the level of serum ferritin (SF) before transplantation divided patients into two groups: the effective treatment group (SF<1 000 μg/L) and iron overload group (SF≥1 000 μg/L).
  
  
  RESULTS
  ①30/57 cases were received iron chelation treatment, 27/57 patients didn' t received iron chelating therapy before transplantation. 19/30 cases were in the effective treatment group, and the median SF level before transplantation was 561 (223-846) μg/L. 11/30 cases were in the iron overload group, and the median SF level before transplantation was 1 262 (1 100-2 352) μg/L. The median SF level was 1 540 (1 320-3 112) μg/L of 27 patients didn't received iron chelating therapy before transplantation. ② The rate of fully-engraftment in the effective treatment group and iron overload group was 19 cases (100.0% ) and 34 cases (89.5% ), myeloid reconstitution of 12(10-18) and 12(11-30) days respectively (P=0.441), and platelet reconstitution of 13(12-30) and 15 (10-32) days respectively (P=0.579). ③The infection risk rate of the effective treatment group was less than iron overload group [36.8% (7/19) vs 82.4% (28/34), P=0.002]. ④The incidence of aGVHD in effective treatment group was less than iron overload group [26.3%(5/19) vs 64.7%(22/34), P= 0.010]. All patients of the effective treatment group were Ⅰ/Ⅱ degree. 16 cases were Ⅰ/Ⅱ degree and 6 cases were Ⅲ/Ⅳ degree in the iron overload group. ⑤ 6 cases of iron overload group accepted iron chelation treatment early post-transplantation, and SF level decreased from 2 870 (2 205-3 580) μg/L to 1 270 (1 020-1 650) μg/L. ⑥The difference of median disease-free survival time between the effective treatment group and iron overload group was not statistically significant [28.9 (0.3-89.5) months vs 21.2(0.1-81.0) months, χ(2)=3.751, P=0.053].
  
  
  CONCLUSIONS
  Iron overload obviously increased transplant-related complications, and effective iron chelation therapy before transplantation significantly decreased the incidence of infection and degree of aGVHD, thereby reduced the non-relapse mortality in patients with MDS.
authors.affiliation: Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou 215006, China.
authors.forename: C H
authors.initials: CH
authors.lastname: Gu
authors.forename: C X
authors.initials: CX
authors.lastname: Li
authors.forename: L
authors.initials: L
authors.lastname: Ye
authors.forename: H
authors.initials: H
authors.lastname: Liu
authors.forename: J F
authors.initials: JF
authors.lastname: Ma
authors.forename: T
authors.initials: T
authors.lastname: Wang
authors.forename: Q
authors.initials: Q
authors.lastname: Zou
authors.forename: J
authors.initials: J
authors.lastname: Chen
authors.forename: X C
authors.initials: XC
authors.lastname: Chen
authors.forename: D P
authors.initials: DP
authors.lastname: Wu
mesh_terms: D015913:Chelation Therapy; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007501:Iron / Q000097:blood; D019190:Iron Overload / Q000628:therapy*; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007501:Iron