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

Abstract

Iron overload increases the risk of infections, veno-occlusive disease and hepatic dysfunction in post-transplant period. Our objective was to investigate the association of pre-transplant ferritin levels with complications and survival after allogeneic hematopoietic stem cell transplantation (alloHSCT).We retrospectively analysed 84 patients' data who had undergone allogeneic HSCT into two groups: patients with a serum ferritin level≥1000ng/ml, and patients with <1000 ng/ml at the time of HSCT.Cox-regression analysis showed that pre-transplant serum ferritin levels were significantly higher in patients who had at least one infectious event compared with those who had no any infectious event in the post-transplant 100 days (p<0.023). Overall survival (OS) and disease-free survival (DFS) rates were significantly higher in patients with a time-to-tx interval <12 months compared with group time-to-tx interval>12 months (p=0.002 and p=0.008 respectively). A higher risk of death was observed in high-ferritin group (hazard ratio=2.27, CI:1.01-5.09, p=0.023 for OS and hazard ratio=2.49, CI:1.12-5.53 p=0.039 for DFS). No significant effect on OS and DFS among groups was observed for variables conditioning regimen, gender and diagnosis. Acute GVHD was more common in patients with a ferritin level ≥1000 ng /mL, but this was not statistically significant (p>0.05). There was no statistical significance in both groups (ferritin≥1000ng /mL and ferritin<1000ng/mL) for relapse rates (p>0.05). Platelet and neutrophil engaftment day was not found statistically significant compared with both groups (p=0.273 and p=0.882, respectively).Pre-transplant ferritin levels may predict poor outcomes in patients who had undergone allogeneic hematopoietic stem cell transplantation.

A Novel Differential Predict Model Based on Matrix-Assisted Laser Ionization Time-of-Flight Mass Spectrometry and Serum Ferritin for Acute Graft-versus-Host Disease

“…Therefore, we constructed the models combined with serum ferritin. Iron overload increases the risk of infections, venoocclusive disease and hepatic dysfunction in posttransplant period [12], which is also proved by our statistical data. Our statistics reports that SF concentrations of our patients all exceed the upper line.…”

“…Iron overload is frequently observed in patients with hepatopathy, cancer, and hematologic diseases, and serum ferritin is the most sensitive indicator for iron metabolism. Previous studies have shown that, during allo-HSCT, elevated pretransplant serum ferritin level is associated with a higher incidence of treatment-related complications [7, 12–14]. However, the specificity and sensitivity of sole serum ferritin to aGVHD are very limited due to individual diversity.…”

Phase IV open-label study of the efficacy and safety of deferasirox after allogeneic stem cell transplantation

“…Elevated serum ferritin levels prior to transplant have also been associated with a lower survival rate, and increased overall and treatment-related mortality in patients undergoing HSCT for hematologic malignancies. 15 In a study of 112 adults who had undergone allo-HSCT, causes of death within 100 days after transplant among the patients with high serum ferritin were infection (29%), organ failure (29%), GvHD (29%) and SOS (14%). 7 Regarding the effects of persistent iron overload on the long-term morbidity of HSCT survivors, Meyer et al found that, in 290 allo-HSCT recipients, hyperferritinemia had a detrimental effect on post-HSCT survival (0-6 months P<0.001; 6-12 months P<0.001; 1-2 years P=0.02; 2-5 years P=0.002).…”

Pretransplant serum beta‐2 microglobulin level is a potential novel prognostic marker of overall survival after allogeneic hematopoietic cell transplantation – a retrospective observational study

“…We evaluated our cohort using HCT‐CI and DRI, which were confirmed as prognostic prediction models in accordance with previous reports . Additionally, we collected other clinical and laboratory data at transplant that served as prognostic factors, including patients’ age , performance status , tumor and inflammatory biomarkers, such as ferritin , albumin , and C‐reactive protein , within a month before the start of the conditioning regimen for allo‐HCT. Furthermore, we collected the serum data of creatinine and the estimated glomerular filtration rate evaluated for patients’ renal function analysis at transplant that could be associated with serum BMG .…”