Unbalance in Iron Metabolism in Childhood Leukemia Converges with Treatment Intensity: Biochemical and Clinical Analysis

Abstract

Objective: The aim of this study was to evaluate non-transferrin-bound iron (NTBI) and labile plasma iron (LPI) levels and other parameters of iron metabolism in children undergoing therapy for acute leukemia or after hematopoietic cell transplantation (HCT), in the context of iron overload. Patients: A total number of 85 children were prospectively included into four groups: controls, acute leukemia de novo, acute leukemia after intensive treatment, and after HCT. Methods: The following iron metabolism parameters were analyzed: (1) parameters measuring functional and storage iron pools: NTBI, LPI, iron, transferrin, total iron-binding capacity, ferritin, ferritin heavy and light chains; (2) proteins regulating iron absorption and its release from tissue stores: hepcidin, soluble hemojuvelin, soluble ferroportin-1; (3) proteins regulating the erythropoietic activity of bone marrow: erythroferrone, erythropoietin, soluble transferrin receptor. Results: Intensive treatment of leukemia in children was associated with the presence of serum NTBI and LPI, which was the highest in the HCT group followed by the acute leukemia after treatment and de novo groups. In patients after HCT, the most significant changes were found in NTBI, LPI, iron, ferritin, hepcidin, and ferroportin-1 levels. Conclusions: The occurrence of NTBI and LPI in the circulation and the intensification of disturbances in iron metabolism were associated with the intensity of the anti-leukemic treatment.

A Retrospective Cohort Study of the Efficacy, Safety, and Clinical Value of 6-TG versus 6-MP Maintenance Therapy in Children with Acute Lymphoblastic Leukemia

“…The relationship between methylated mercaptopurine metabolites and TGN will serve as a mature part of elucidating the clinical outcome of 6-MP. In clinic, the treatment of mercaptopurine in children with ALL is complicated in terms of dosage, course of treatment, drug selection, and remediation of side effects [ 36 ]. The therapeutic effect of ALL was also related to disease grade, sex, and age of patients.…”

Environmental Risk Factors for Childhood Acute Lymphoblastic Leukemia: An Umbrella Review

“…While treatment and survival from childhood ALL has remarkably improved over the past decades [ 3 ], survivors are yet at risk of a wide spectrum of somatic late effects, and adverse psychosocial and socioeconomic consequences during later life, including treatment-induced second malignancies [ 16 ]. Therefore, establishing primary preventive measures remains the central goal with identifying modifiable risk factors being essential, as only few risk factors have been established so far.…”

Biomarkers of Myocardial Injury and Remodeling in Heart Failure

“…However, this invasive procedure is now rarely used, being replaced by the assessment of several blood-borne biomarkers to depict iron status and diagnose ID. The iron biomarkers with established clinical recommendations in HF are briefly discussed below and presented in Table 3 [ 66 ].…”

“…Ferritin is an iron storage protein secreted by the liver and reticuloendothelial system; its levels in the serum correspond to its expression in the iron-storing tissues [ 63 , 67 ]. One significant disadvantage is that serum ferritin can be non-specifically elevated due to inflammation, which is present in HF but also in other chronic comorbidities [ 65 , 66 ].…”