Prevalence and risk factors of iron overload after hematopoietic stem cell transplantation for childhood acute leukemia: a LEA study.
Data on post-transplant iron overload (IO) are scarce in pediatrics. We conducted a prospective multicenter cohort study (Leucémie de l'Enfant et de l'Adolescent cohort) to determine the prevalence and risk factors of IO in 384 acute leukemia survivors transplanted during childhood. Prevalence of IO (ferritin level ⩾350 ng/mL) was 42.2% (95%CI 37.2-47.2%). Factors significantly associated with IO were: 1) in univariate analysis: older age at transplant (P<0.001), allogeneic versus autologous transplantation (P<0.001), radiation-based preparative regimen (P=0.035) and recent period of transplantation (P<0.001); 2) in multivariate analysis: older age at transplant in quartiles (Odds Ratio (OR)=7.64, 95% CI: 3.73-15.64 for age >12.7 years and OR=5.36, 95% CI: 2.63-10.95 for age from 8.2 to 12.7 years compared to age < 4.7 years), acute myeloid leukemia (OR=3.23, 95% CI: 1.47-7.13), allogeneic graft (OR=4.34, 95% CI: 2.07-9.12 for alternative donors and OR=2.53, 95% CI: 1.2-5.33 for siblings, compared to autologous graft) and radiation-based conditioning regimen (OR=2.45, 95% CI: 1.09-5.53). Graft-versus-host disease was an additional risk factor for allogeneic graft recipients. In conclusion, IO is a frequent complication in pediatric long-term survivors after transplantation for acute leukemia, more frequently observed in older children, those transplanted from alternative donors or with graft-versus-host disease.
Department of Pediatric Hematology and Oncology, University Hospital, Montpellier, France.
A
A
Sirvent
Research Unit EA 3279 and Department of Public Health, Aix-Marseille University and Timone Hospital, Marseille, France.
P
P
Auquier
Research Unit EA 3279 and Department of Public Health, Aix-Marseille University and Timone Hospital, Marseille, France.|Department of Pediatric Hematology and Oncology, Timone Enfants Hospital and Aix-Marseille University, Marseille, France.
C
C
Oudin
Department of Pediatric Hematology and Oncology, University Hospital, Lyon, France.
Y
Y
Bertrand
Department of Pediatric Hematology and Oncology, University Hospital, Montpellier, France.
S
S
Bohrer
Department of Pediatric Hematology and Oncology, Hôpital d'Enfants de Brabois, Vandoeuvre Les Nancy, France.
P
P
Chastagner
Department of Pediatric Hematology and Oncology, University Hospital L'Archet, Nice, France.
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M
Poirée
Department of Pediatric Hematology and Oncology, University Hospital, Clermont-Ferrand, France.
J
J
Kanold
Department of Pediatric Hematology and Oncology, University Hospital, Saint Etienne, France.
S
S
Thouvenin
Department of Pediatric Hematology and Oncology, University Hospital, Bordeaux, France.
Y
Y
Perel
Department of Pediatric Hematology and Oncology, University Hospital, Grenoble, France.
D
D
Plantaz
Department of Pediatric Hematology and Oncology, Trousseau Hospital, Paris, France.
M-D
MD
Tabone
Department of Pediatric Hematology- Immunology, Robert Debré Hospital, and Paris Diderot University, Sorbonne Paris-Cité, Paris, France.
K
K
Yakouben
Department of Pediatric Hematology and Oncology, University Hospital, Rennes, France.
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V
Gandemer
Department of Pediatric Hematology-oncology, Hospital University, Strasbourg, France.
P
P
Lutz
Department of Pediatric Hematology and Oncology, University Hospital, Montpellier, France.
N
N
Sirvent
Research Unit EA 3279 and Department of Public Health, Aix-Marseille University and Timone Hospital, Marseille, France.
C
C
Vercasson
Research Unit EA 3279 and Department of Public Health, Aix-Marseille University and Timone Hospital, Marseille, France.
J
J
Berbis
Department of Pediatric Hematology and Oncology, Timone Enfants Hospital and Aix-Marseille University, Marseille, France.
H
H
Chambost
Department of Pediatric Hematology and Oncology, Trousseau Hospital, Paris, France.
G
G
Leverger
Department of Pediatric Hematology- Immunology, Robert Debré Hospital, and Paris Diderot University, Sorbonne Paris-Cité, Paris, France.
A
A
Baruchel
Research Unit EA 3279 and Department of Public Health, Aix-Marseille University and Timone Hospital, Marseille, France.|Department of Pediatric Hematology and Oncology, Timone Enfants Hospital and Aix-Marseille University, Marseille, France.
G
G
Michel
D000367:Age Factors; D064591:Allografts; D000073116:Cancer Survivors; D002648:Child; D005260:Female; D005293:Ferritins / Q000097:blood*; D006086:Graft vs Host Disease / Q000097:blood / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D019190:Iron Overload / Q000097:blood* / Q000453:epidemiology*; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D015995:Prevalence; D012307:Risk Factors; D014019:Tissue Donors; D019172:Transplantation Conditioning
D005293:Ferritins