The relationship between iron bone marrow stores and response to treatment in pediatric acute lymphoblastic leukemia

Abstract

Iron is an intracellular element whose accumulation in the body is associated with tissue damage. This study examines the effect of iron on pediatric acute lymphoblastic leukemia (ALL) and its “response to treatment.” At the end of the first year of treatment, bone marrow iron store (BMIS) was evaluated in children with ALL and the relationship between iron store and minimal residual disease was investigated. Moreover, the 3-year disease-free survival (3-DFS) of patients was determined. Patients’ BMIS were compared with that of subjects with normal bone marrow. The study examined 93 children, including 78 Pre-B and 15 T-cell ALL patients. BMIS did not differ between the children with ALL and those with no evidence of cancer. BMIS was increased in 26.6% of patients at the end of the first year of treatment. Drug resistance and BM relapses were more prevalent in cases with high BMIS in both Pre-B and T-cell groups. Bone marrow iron store is not considered a risk factor for childhood ALL. However, high levels of BMIS are associated with poor response to treatment and the risk of relapse. Bone marrow iron store control during treatment can therefore help achieve better outcomes and improve the chances of recovery.

Serum ferritin level in pediatric patients with acute lymphoblastic leukemia (ALL) in the early stage of diagnosis and remission phase

“…22 On the order hand, in the research by Moafi et al involving pediatric patients with ALL, iron levels were the same at the beginning of diagnosis between the case and control group. 23,24 In the research, however, the number of samples was small. Therefore, the role of iron in ALL development could not be concluded.…”

“…Moreover, patients with higher iron levels in the bone marrow had a higher relapse rate. 23 Iron can become a prognostic factor in children with leukemia. 16 Iron overload that develops in children with cancer is due to receiving many blood transfusions, which is linked to a poor prognosis and significantly becomes morbidity and mortality factors.…”

Preliminary Study of Confounder‐Corrected Fat Fraction and R2* Mapping of Bone Marrow in Children With Acute Leukemia

“…In AL, the decreased iron content in the BM may be caused by the special iron intake mechanism to obtain iron from the host to meet the abnormal proliferation needs of leukemia cells. Regarding the significance of BM iron content in patients with AL, research suggests that reduced BM iron storage can increase the response of patients with ALL 19 . Iron overload (grade ≥3) will increase patients’ tolerance to treatment and BM recurrence risk 19 .…”

“…Brissot et al mentioned in the study that excessive iron in leukemia patients has harmful effects on both hematopoietic function and prognosis, especially after hematopoietic stem cell transplantation 31 . Moafi et al reported that the increase of BM iron storage (BMIS) at the end of the first year of treatment was related to the incidence of drug resistance and the risk of relapse 19 . Therefore, MGRE could also be a useful tool to monitor the variation of iron content in BM during the treatment of leukemia.…”

The progress in the relationship between trace elements and acute lymphoblastic leukemia

“…They found that deferoxamine (DFO) prevents ALL proliferation and induces cell apoptosis by down-regulating the ROS/HIF-1ɑ, Wnt/β-catenin, and p38/MAPK/ERK signaling pathway ( You et al, 2022 ). Moreover, there is a parallel relationship between the serum ferritin content and the number of immature cells ( Moafi et al, 2017 ; Abedi et al, 2020 ). Red blood cell infusion is a common treatment method for ALL children receiving chemotherapy.…”