Frequent severe liver iron overload after stem cell transplantation and its possible association with invasive aspergillosis

Abstract

Summary:Iron overload is associated with free radical generation and tissue damage. Our main objective was to ascertain the frequency and severity of iron overload in a group of 59 patients who died after conventional-intensity autologous (n ¼ 24) or allogeneic (n ¼ 35) haematopoietic stem cell transplantation (HSCT). A second objective was to investigate associations between liver-iron concentration and causes of transplant-related mortality. The median age was 41 years (range, 19-66), 41 were males and 18 females. In total, 26 patients had acute leukaemia or MDS, 10 CML, 17 lymphoma, four myeloma and two aplastic anaemia. The median hepatic iron concentration (HIC) was 138 lmol/g dry weight (7.7 mg/g; range 31-631 lmol/g). In total, 4/32 (12%) patients with HIC o150 lmol/g and 10/27 (37%) with hepatic iron X150 lmol/g showed invasive aspergillosis at autopsy (P ¼ 0.035). This was significant in multivariate analysis (RR 9.0; 95% CI 1.6-50.3, P ¼ 0.012). In conclusion, severe iron overload is frequent in patients who die following HSCT and is associated with invasive aspergillosis.

Pretransplant serum ferritin level may be a predictive marker for outcomes in patients having undergone allogeneic hematopoietic stem cell transplantation

“…Elevated levels of pre-transplant ferritin were found to be associated with increased rates of fungal infections in alloHSCT recipients [16,17]. In our patients, there was a remarkable association between serum ferritin levels and infectious events, including pneumonia, of which the majority had a fungal origin.…”

“…41 (48.8%) of the patients were female, and 43 (51.2%) were male. The majority of the patients was diagnosed with AML (37, 44.1%), while the others were ALL (16,19.1%), aplastic anemia (16,19.1%), non-Hodgkin lymphoma (5, 5.8%), chronic myelogenous leukemia (2, 2.3%), and others (8, 9.6%). The median age was found to be 28 years (min-max: Table 2.…”

The role of liver biopsy in the workup of liver dysfunction late after SCT: is the role of iron overload underestimated?

“…18,21,24,[28][29][30] Previous reports have documented an association between mucositis, opportunistic infections including aspergillus and mucor mucosis, febrile days, GVHD, SOS/VOD, hepatitis C and finally survival. 1,19,26,[31][32][33][34][35] Patients with hemachromatosis have an increased incidence of cirrhosis, hepatocellular carcinoma and some other malignancies. [35][36][37][38][39][40] Similarly, CLD is one of the major long-term complications in HSCT survivors.…”

Clinical significance of pretransplant serum ferritin on the outcome of allogeneic hematopoietic SCT: a prospective cohort study by the Kanto Study Group for Cell Therapy

“…Recent studies have demonstrated that pretransplant iron overload, defined as elevated serum ferritin levels, is associated with worse OS, disease-free survival and non-relapse mortality (NRM) and with an increased risk of infection in patients undergoing allogeneic HSCT. [1][2][3][4][5][6][7][8][9] Liver dysfunction caused by iron overload 10 and neutrophil dysfunction with an increase in non-transferrin-bound iron levels 11,12 may have a negative impact on HSCT outcomes. However, most previous studies involved retrospective analyses of patients with heterogeneous diseases.…”