Measurement of liver iron concentration by superconducting quantum interference device biomagnetic liver susceptometry validates serum ferritin as prognostic parameter for allogeneic stem cell transplantation

Jacobi, Nicole; Herich, Lena

doi:10.1111/ejh.12734

Cited by 17 publications

(14 citation statements)

References 17 publications

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“…A disadvantage is that SF is an acute phase protein; therefore, SF levels may also be impacted by events such as tissue injury and inflammation. Despite this, SF has been a frequent assessment in clinical trials, and an SF level of ≥ 1,000 ng/mL has recently been validated as a marker of IO and poor prognosis following ASCT (Jacobi & Herich, 2016). In this study, iron levels as measured by a superconducting quantum interference device (SQUID) correlated highly with SF levels (r = .6; p < .001), and SF was predictive of worse overall and event-free survival (Jacobi & Herich, 2016).…”

Section: Current Methods For Diagnosis Of Iron Overloadmentioning

confidence: 79%

“…Despite this, SF has been a frequent assessment in clinical trials, and an SF level of ≥ 1,000 ng/mL has recently been validated as a marker of IO and poor prognosis following ASCT (Jacobi & Herich, 2016). In this study, iron levels as measured by a superconducting quantum interference device (SQUID) correlated highly with SF levels (r = .6; p < .001), and SF was predictive of worse overall and event-free survival (Jacobi & Herich, 2016). Another study suggested that SF is a reasonable surrogate to detect IO in patients undergoing ASCT, although the authors propose increasing the threshold to 2,500 ng/mL (Armand et al, 2011).…”

Section: Current Methods For Diagnosis Of Iron Overloadmentioning

confidence: 99%

“…Accordingly, retrospective and observational studies have suggested patients with MDS and IO have a markedly increased risk of death compared with MDS patients without IO (Adams & Bird, 2013;Mitchell et al, 2013;Shah et al, 2012;Steensma & Gattermann, 2013;Wood, 2015). Iron overload in MDS patients may also be a risk factor leading to poor outcomes following allogeneic stem cell transplant (ASCT; Jacobi & Herich, 2016;Wermke et al, 2012).…”

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confidence: 99%

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Iron Overload in Myelodysplastic Syndromes: Pathophysiology, Consequences, Diagnosis, and Treatment

Lyle¹,

Hirose²

2018

JADPRO

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Myelodysplastic syndromes (MDS) are a heterogeneous group of hematologic neoplasms varying in severity affecting one or more lines of hematopoiesis. Ineffective erythropoiesis results in dysregulation of iron metabolism. Most MDS patients have anemia, and some require regular red blood cell transfusions. These transfusions, in addition to factors of the disease itself, can result in iron overload (IO). Retrospective analyses suggest that MDS patients with IO have reduced overall survival and poorer outcomes following allogeneic stem cell transplant vs. those without IO. Iron chelation therapy (ICT; deferoxamine, deferasirox, or deferiprone) has been used to alleviate IO in other transfusiondependent hematologic conditions (e.g., thalassemia), but its role in MDS has not been firmly established. A growing body of evidence suggests that ICT in MDS patients is an effective means for reducing transfusional IO and may significantly improve outcomes such as survival. The orally administered iron chelator deferasirox has been widely studied in MDS, and available studies have shown it to be generally well tolerated and effective in reducing IO in this population. The pathophysiology and clinical consequences of IO in MDS, as well as current methods for diagnosing and treating IO in these patients, are discussed.

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Section: Current Methods For Diagnosis Of Iron Overloadmentioning

confidence: 79%

Section: Current Methods For Diagnosis Of Iron Overloadmentioning

confidence: 99%

mentioning

confidence: 99%

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Iron Overload in Myelodysplastic Syndromes: Pathophysiology, Consequences, Diagnosis, and Treatment

Lyle¹,

Hirose²

2018

JADPRO

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“…The rate ratio for fungal infections remained unchanged after adjustment for aGVHD grades II-IV (RR 5 2.76, 95% confidence interval [CI] 1.1–6.7, P 5 .01), indicating there was no evidence of confounding by aGVHD. Another important risk factor advocated for an increased peritransplant mortality, and in particular due to the infections is the iron overload 86 – 91 The ferritinemia (SF) is considered the standard method for measuring iron overload. However, the optimal parameters and time points for the measurement of iron overload (IO) in allogeneic stem cell transplantation (ASCT) patients are still under discussion.…”

Section: Intermediate 2 and High Risk Mdsmentioning

confidence: 99%

Infections in Myelodysplastic Syndrome in Relation to Stage and Therapy

Leone

Pagano

2018

Mediterr J Hematol Infect Dis

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Infections remain a significant problem in myelodysplastic syndromes (MDS) in treated as well in non-treated patients and assume a particular complexity. The susceptibility to infections is due, in the absence of intensive chemotherapies, mainly to functional defects in the myeloid lineage with or without neutropenia. Furthermore, MDS includes a heterogeneous group of patients with very different prognosis, therapy and risk factors regarding survival and infections. You should distinguish risk factors related to the disease, like as neutrophils function impairment, neutropenia, unfavorable cytogenetics and bone marrow insufficiency; factors related to the patient, like as age and comorbidities, and factors related to the therapy. When the patients with MDS are submitted to intensive chemotherapy with and without hematopoietic stem cell transplantation (HSCT), they have a risk factor for infection very similar to that of patients with acute myeloid leukemia (AML), and mostly related to neutropenia. Patients with MDS treated with supportive therapy only or with demethylating agent or lenalidomide or immunosuppressive drugs should have a tailored approach. Most of the infections in MDS originate from bacteria, and the main risk factors are represented by neutropenia, thrombocytopenia, and unfavorable cytogenetics. Thus, it is reasonable to give antibacterial prophylaxis to patients who start the therapy with demethylating agents with a number of neutrophils <500 × 109/L, or with thrombocytopenia and unfavorable cytogenetics. The antifungal prophylaxis is not considered cost/benefit adequate and should be taken into consideration only when there is an antecedent fungal infection or presence of filamentous fungi in the surveillance cultures. Subjects submitted to immunosuppression with ATG+CSA have a high rate of infections, and when severely neutropenic should ideally be nursed in isolation, should be given prophylactic antibiotics and antifungals, regular mouth care including an antiseptic mouthwash.

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“…SF is commonly used as a marker of iron overload (defined as SF ≥1000 ng/mL) [1], but this role has been often questioned, as SF value can be affected by acute infections, inflammations, and even malignant conditions, so that it is also considered as an acute phase protein. Several studies have evaluated tests other than the evaluation of SF level to estimate iron overload, such as Magnetic Resonance Imaging (MRI) and Superconducting Quantum Interference Device (SQUID) biomagnetic liver susceptometry [2–4]; however, SF is still considered the most adequate surrogate parameter for body iron overload concentration, as recently confirmed [4]. …”

Section: Introductionmentioning

confidence: 99%

Role of serum ferritin level on overall survival in patients with myelodysplastic syndromes: Results of a meta-analysis of observational studies

et al. 2017

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BackgroundThe role of serum ferritin (SF) as a prognostic factor has been analyzed in patients with myelodysplastic syndromes (MDS) who have undergone hematopoietic stem cell transplantation (HSCT), but the prognostic role of elevated SF levels is still controversial in lower risk MDS patients. Therefore, we performed a meta-analysis of all available published literature to evaluate whether elevated SF levels are associated with a worse overall survival (OS) among patients with low risk MDS.Material and methodsA systematic bibliographic search of relevant studies was undertaken in accordance with guidelines for meta-analysis of observational studies in epidemiology. Electronic databases were searched through July 2016 for studies examining the level of SF as a prognostic factor in the adults affected by MDS.ResultsSix articles were included in the meta-analysis. A significant association between OS and SF was achieved for the threshold of SF≥1000 ng/mL, when the only study that used SF cut-off ≥2000 ng/mL was not included in the meta-analysis (RR = 1.33; 95% CI = 1.06–1.67). The estimated risk was 2.58 (95% CI = 1.41–4.74) when a SF cut-off≥500 ng/mL was considered.ConclusionsOur findings underlined a worse survival in patients with MDS who had higher SF levels. The association was stronger and achieved statistical significance after stratification of analyses in which we excluded cut-offs of SF level considered as outliers. These results suggest that negative impact on OS already exist at SF level ≥500 ng/mL. Prospective studies, are needed to better understand this relationship and, above all, to clarify whether earlier iron chelation therapy could improve patients’ OS.

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Measurement of liver iron concentration by superconducting quantum interference device biomagnetic liver susceptometry validates serum ferritin as prognostic parameter for allogeneic stem cell transplantation

Cited by 17 publications

References 17 publications

Iron Overload in Myelodysplastic Syndromes: Pathophysiology, Consequences, Diagnosis, and Treatment

Iron Overload in Myelodysplastic Syndromes: Pathophysiology, Consequences, Diagnosis, and Treatment

Infections in Myelodysplastic Syndrome in Relation to Stage and Therapy

Role of serum ferritin level on overall survival in patients with myelodysplastic syndromes: Results of a meta-analysis of observational studies

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