Evaluation of Liver Iron Content by Magnetic Resonance Imaging in Children with Acute Lymphoblastic Leukemia after Cessation of Treatment

Abstract

Objective: There are limited number of studies evaluating iron overload in childhood leukemia by magnetic resonance imaging (MRI). The aim of this study was to determine the liver iron content (LIC) by MRI in children with acute lymphoblastic leukemia (ALL), who had been completed treatment, and to compare with serum iron parameters. Materials and Methods: A total of 30 patients between the ages of 7 and 18 who completed ALL treatment were included in the study. Serum iron parameters [serum iron, serum ferritin (SF), and total iron binding capacity], liver function tests were studied. R2 MRI was performed for determining LIC. Results: Normal LIC were detected in 22 (63.4%) of the cases. Seven (23.3%) had mild and 1 (3.3%) had moderate liver iron deposition. In contrast, severe iron overload was not detected in any of the cases. LIC levels were correlated with the numbers of packet red blood cell (pRBC) transfusions (r = 0.637, p <0.001), pRBC transfusion volume (r = 0.449, p <0.013), SF levels (r = 0.561, p = 0.001), transferrin saturation (r=0.353 , p = 0.044). In addition, a positive correlation was found between the number of pRBC transfusions and SF levels (r = 0.595, p <0.001). Conclusion:We showed that the frequency of liver iron deposition was low and clinically less significant after the end of the treatment in childhood ALL patients. LIC was u n c o r r e c t e d p r o o f demonstrated to be related with SF and transfusion history. These findings support that SF and transfusion history may be used as a reference for monitoring iron accumulation or identifying cases for further examination such as MRI. Tedavisi Tamamlanmış Akut Lenfoblastik Lösemili Çocuklarda Manyetik Rezonans Görüntüleme ile Karaciğer Demir İçeriğinin Değerlendirilmesi ÖzAmaç: Çocukluk çağı lösemisinde aşırı demir yükünü manyetik rezonans görüntüleme (MRG) ile değerlendiren sınırlı sayıda çalışma vardır. Bu çalışmanın amacı, ALL'ı olan ve tedavisini tamamlamış olan çocuklarda R2 MRI yöntemiyle karaciğer demir içeriğini (LIC) belirlemek ve serum demir parametreleriyle karşılaştırmaktır. Gereç ve Yöntem: Çalışmaya ALL tedavisini tamamlayan 7-18 yaşları arasında toplam 30 hasta alındı. Serum demir parametreleri [serum demir, serum ferritin (SF) ve toplam demir bağlama kapasitesi], karaciğer fonksiyon testleri çalışıldı. Karaciğer demir içeriğini (LIC) belirlemek için R2 MRG yöntemi kullanıldı. Bulgular: Olguların 22'sinde (% 63,4) normal LIC saptandı. Yedi (% 23,3) olguda hafif ve 1 (% 3,3) olguda orta derecede karaciğerde demir birikimi mevcuttu. Buna karşılık, hiçbir olguda ciddi derecede demir birikimi tespit edilmedi. LIC seviyeleri, pRBC transfüzyonu sayısı (r = 0.637, p <0.001), pRBC transfüzyon miktarı (r = 0.449, p <0.013), SF seviyeleri (r = 0.561, p = 0.001), transferrin (r = 0.353, p = 0.044) ile korele saptandı. Ek olarak, pRBC transfüzyonlarının sayısı ile SF seviyeleri arasında pozitif korelasyon bulundu (r = 0.595, p <0.001). Sonuç: Çocukluk çağı ALL hastalarında tedavi bitiminden sonra karaciğer demir birikiminin sıklığının...

Iron Overload in Children With Leukemia; Identification of a Cutoff Value for Serum Ferritin Level

“…Many patients with iron overload fell into the mild category, except for 1 patient with a moderate degree of iron overload in the heart and 6 patients with moderate or severe degrees of iron overload in the liver. Our findings are consistent with a study conducted by Acar et al, 17 which reported mild to moderate liver iron overload in 7 of 30 patients with ALL. In addition, a study by Unal et al 18 reported frequencies of 50% for hepatic and 27% for cardiac iron deposition in pediatric patients with ALL.…”

“…Their findings also demonstrated a positive correlation between the number and volume of erythrocyte transfusions, LIC, and serum ferritin levels. 17 These results further support the notion that transfusion history plays a role in the development of iron overload in leukemia patients. Consistent with these previous studies, our findings indicate that the total volume of blood transfusion per kilogram of body weight was significantly higher in patients with iron overload compared with those without iron overload.…”

“…Several studies showed the increased level of serum ferritin among patients diagnosed with leukemia during early and late stages and, after the cessation of treatment. [17][18][19][20][21][22][23] Importantly, a significant proportion of patients (33.3%) exhibited serum ferritin levels above the threshold of 1000 ng/ mL, which is considered indicative of iron overload. This observation further supports the association between leukemia and elevated ferritin levels, suggesting a dysregulation in iron metabolism during the disease course.…”

“…Another study also evaluated this threshold and reported that iron overload can be present with serum ferritin values below 1000 ng/mL. 17 Therefore, they recommended further studies to determine a more precise cutoff point for serum ferritin levels. The lower cutoff point identified in our study compared with other research may be attributed to several factors.…”

“…Several studies showed the increased level of serum ferritin among patients diagnosed with leukemia during early and late stages and, after the cessation of treatment 17–23 . Importantly, a significant proportion of patients (33.3%) exhibited serum ferritin levels above the threshold of 1000 ng/mL, which is considered indicative of iron overload.…”