Prognostic Value and Clinical Implication of Serum Ferritin Levels following Allogeneic Hematopoietic Cell Transplantation

Nakamae, Mika; Nakamae, Hirohisa; Koh, Shiro; Koh, Hideo; Nishimoto, Mitsutaka; Nakashima, Yasuhiro; Nakane, Takahiko; Hirose, Asao; Hino, Masayuki

doi:10.1159/000365779

Cited by 5 publications

(4 citation statements)

References 20 publications

(24 reference statements)

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“…Nakamae et al showed a significant relation of serum ferritin levels at day 30 and 1 year after HSCT with OS [30]. …”

Section: Iron Overload and Related Complications In Hematopoietic Stementioning

confidence: 99%

Current Review of Iron Overload and Related Complications in Hematopoietic Stem Cell Transplantation

Atilla¹,

Toprak²,

Demirer

2017

Tjh

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Iron overload is an adverse prognostic factor for patients undergoing hematopoietic stem cell transplantation (HSCT). In the HSCT setting, pretransplant and early posttransplant ferritin and transferrin saturation were found to be highly elevated due to high transfusion requirements. In addition to that, post-HSCT iron overload was shown to be related to infections, hepatic sinusoidal obstruction syndrome, mucositis, liver dysfunction, and acute graft-versus-host disease. Hyperferritinemia causes decreased survival rates in both pre- and posttransplant settings. Serum ferritin levels, magnetic resonance imaging, and liver biopsy are diagnostic tools for iron overload. Organ dysfunction due to iron overload may cause high mortality rates and therefore sufficient iron chelation therapy is recommended in this setting. In this review the management of iron overload in adult HSCT is discussed.

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“…Nakamae et al showed a significant relation of serum ferritin levels at day 30 and 1 year after HSCT with OS [30]. …”

Section: Iron Overload and Related Complications In Hematopoietic Stementioning

confidence: 99%

Current Review of Iron Overload and Related Complications in Hematopoietic Stem Cell Transplantation

Atilla¹,

Toprak²,

Demirer

2017

Tjh

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“…We monitored serum ferritin levels using the architect ferritin assay system (Abbott Japan Co., Ltd. Chiba, Japan). Measurements were performed once a week during hospitalization and after allo-HCT, at day 30 ± 5 days, day 60 ± 7 days, day 90 ± 10 days, 180 ± 30 days, and thereafter every 12 months ± 2 months, or when an attending physician suspected the onset of HPS according to the institution's manual [21].…”

Section: Chemokinesmentioning

confidence: 99%

Diagnostic value of serum ferritin and the risk factors and cytokine profiles of hemophagocytic syndrome following allogeneic hematopoietic cell transplantation

Nanno

Koh

Nakashima

et al. 2016

Leukemia & Lymphoma

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To examine the diagnostic value of serum ferritin, the associated risk factors, and cytokine profiles of hemophagocytic syndrome (HPS) following allogeneic hematopoietic cell transplantation (allo-HCT), we retrospectively analyzed data from patients undergoing allo-HCT between 2006 and 2012. Of 223 eligible patients, 18 patients developed HPS. A serum ferritin level above 30,000 μg/l was highly specific for the detection of HPS (specificity, 93%). The one-year survival rate for HPS was significantly lower than that of non-HPS patients (37.5% vs. 72.9%, respectively, Log-rank p < .01). In multivariable Cox models, antigen mismatches in human leukocyte antigen (HLA) in both graft-versus-host (GVH) and host-versus-graft (HVG) directions were significantly associated with the incidence of HPS. We found a significant elevation of Th1 cytokine (IFN-γ), Th2 cytokines (IL-10), and chemokines (MCP-1 and IP-10), at the onset of HPS. Our results suggest that allo-reactivity, derived from HLA-mismatch, and possibly causing a cytokine storm, may be associated with HPS development.

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“…Numerous studies on the relationship between pretransplantation iron overload and HSCT have demonstrated that excess iron in the body is associated with lower overall survival and a higher incidence of transplant-related mortality 14–19…”

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confidence: 99%

“…9,13 Numerous studies on the relationship between pretransplantation iron overload and HSCT have demonstrated that excess iron in the body is associated with lower overall survival and a higher incidence of transplant-related mortality. [14][15][16][17][18][19] Even if patients become transfusion-independent after transplantation, their hepatic iron load decreases very gradually, remaining high for up to 5 years and continuing to cause organ damage posttransplant. [20][21][22][23] Patients with iron overload who undergo HSCT were shown to have liver dysfunction and progression to cirrhosis, even years after transplantation.…”

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confidence: 99%

Efficacy and Safety of Iron Chelation Therapy After Allogeneic Hematopoietic Stem Cell Transplantation in Pediatric Thalassemia Patients: A Retrospective Observational Study

Küpesiz

Sivrice²,

Akinel³

et al. 2021

Journal of Pediatric Hematology/Oncology

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Background: Studies on the increased body iron load in patients with thalassemia major have thoroughly demonstrated the problems caused by iron overload. In patients who undergo hematopoietic stem cell transplantation (HSCT) as curative therapy, iron overload continues long after transplantation. There are few pediatric studies on chelation therapy in the posttransplant period. In this study, we present the outcomes of our patients who received posttransplant oral chelation therapy.Patients and Methods: This retrospective observational study evaluated the outcomes of pediatric patients with thalassemia major who used oral chelation therapy after allogeneic HSCT at the Akdeniz University Pediatric Bone Marrow Unit between January 2008 and October 2019.Results: Deferasirox therapy was initiated in 58 pediatric patients who underwent HSCT for thalassemia. Pretreatment mean serum ferritin was 2166 ± 1038 ng/mL. Treatment was initiated at a mean of 12 ± 6.7 months after transplantation and continued for a mean of 15.7 ± 11.5 months. At treatment discontinuation, the mean serum ferritin was 693 ± 405 ng/mL and the mean reduction was −1472.75 ± 1121.09 ng/mL (P < 0.001 vs. posttreatment). Serum ferritin was below 500 ng/mL in 52% of the patients at treatment discontinuation. Manageable side effects such as nausea, vomiting, liver enzyme elevation, and proteinuria were observed in 17% of the patients, while one patient developed ototoxicity.Conclusions: Deferasirox therapy effectively reduces iron overload in the posttransplant period. Studies evaluating the effects of early treatment on the graft may help to establish guidelines for posttransplant chelation therapy. Clear guidelines are needed regarding when to initiate and discontinue treatment.

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Prognostic Value and Clinical Implication of Serum Ferritin Levels following Allogeneic Hematopoietic Cell Transplantation

Cited by 5 publications

References 20 publications

Current Review of Iron Overload and Related Complications in Hematopoietic Stem Cell Transplantation

Current Review of Iron Overload and Related Complications in Hematopoietic Stem Cell Transplantation

Diagnostic value of serum ferritin and the risk factors and cytokine profiles of hemophagocytic syndrome following allogeneic hematopoietic cell transplantation

Efficacy and Safety of Iron Chelation Therapy After Allogeneic Hematopoietic Stem Cell Transplantation in Pediatric Thalassemia Patients: A Retrospective Observational Study

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