Prognostic impact of elevated pretransplantation serum ferritin in patients undergoing myeloablative stem cell transplantation

Abstract

Iron overload could be a significant contributor to treatment-related mortality (TRM) for patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT). We studied 590 patients who underwent myeloablative allogeneic HSCT at our institution, and on whom a pretransplantation serum ferritin was available. An elevated pretransplantation serum ferritin level was strongly associated with lower overall and disease-free survival. Subgroup multivariable analyses demonstrated that this association was restricted to patients with acute leukemia or myelodysplastic syndrome (MDS); in the latter group, the inferior survival was attributable to a significant increase in TRM. There was also a trend toward an increased risk of venoocclusive disease in patients with high ferritin. Our results argue that iron overload plays an important role in transplantation outcome for patients with acute leukemia or MDS, as it does in thalassemia. They also suggest future prospective trials to examine the potential benefit of chelation therapy in this setting. (Blood. 2007;109: [4586][4587][4588]

Elevated pretransplant serum ferritin is associated with inferior survival following nonmyeloablative allogeneic transplantation

“…Of these, only ferritin 41615 ng/ml (P ¼ 0.010, HR ¼ 2.74), older age (P ¼ 0.049, HR ¼ 1.63) and prior transplantation (P ¼ 0.002, HR ¼ 5.78) were adverse prognostic factors. The addition of albumin, a negative acute phase reactant, did not change the prognostic impact of 2 Causes of death in the low and high ferritin groups are given in Table 2.…”

“…Iron overload is a well-established adverse prognostic factor for allogeneic hematopoietic SCT in thalassemia, 1 and elevated pretransplant serum ferritin seems to adversely affect prognosis with myeloablative transplantation 2,3 for other diseases as well, primarily because of increased non-relapse mortality. We analyzed patients who underwent nonmyeloablative preparation for allogeneic transplantation to determine whether the presence of iron overload was also an adverse prognostic factor for patients undergoing nonmyeloablative transplants.…”

“…On the basis of earlier publications, 2,3 we analyzed the data using 1000 ng/ml as a cutoff for pretransplantation serum ferritin. A total of 32 patients with ferritin o1000 ng/ml had better overall survival than those with ferritin 41000 ng/ml (P ¼ 0.047).…”

A prognostic score with pretransplant serum ferritin and disease status predicts outcome following reduced-intensity SCT

“…[1][2][3] Recent studies have demonstrated the prognostic impact of elevated serum ferritin on survival and complications following reduced-intensity SCT (RIST). [3][4][5][6] We previously reported a simple scoring system that consisted of serum ferritin and disease status at transplantation for predicting outcome in patients with AML and myelodysplastic syndrome (MDS).…”

A prospective cohort study of the feasibility and efficacy of iron reduction by phlebotomy in recipients of hematopoietic SCT

“…Iron overload, estimated by increased ferritin, appears to be associated with adverse outcomes and decreased survival. [1][2][3][4] There are several unanswered questions in this area. First, it is not clear how to best measure iron overload in these patients.…”