Iron Metabolism Before Allo-HSCT In Patients With Acute Leukemia And Impact Of Iron Overload On Transplantation

Objective:Iron overload is common in patients with acute leukemia who undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT). We performed a comprehensive analysis of iron parameters to assess these patients’ iron metabolism, and studied the prognostic impact of pretransplant iron overload on the outcome of transplantation.Methods:In this retrospective study, we studied124patients undergoing myeloablative allo-HSCT between2012and2014. Serum iron (SI), serum ferritin (SF), hepcidin (Hepc) and soluble transferrin receptor (sTfR) were measured before transplant. We analyzed the effect of elevated pretransplant ferritin on acute graft versus host disease (aGVHD), infectious complications, overall survival (OS), relapse, and non-relapse mortality (NRM).Results:Date of124patients (including56cases of acute lymphocytic leukemia and68cases of acute myeloid leukemia) were analyzed. Median SI, SF, Hepc and sTfR values were12.15umol/L,667.05ng/ml,369.50ng/L and7.69ng/ml, respectively. Iron overload (defined as SF>1000ng/ml) were observed in27.42%of patients. In patients with AML, pretransplant iron overload was significantly associated with increased risk of bacterial infections, relapse rate and NRM, and with reduced risk of aGVHD. However, in patients with ALL, there were no significant differences.Conclusion:Patients with acute leukemia regularly develop iron overload before they undergoing allo-HSCT. Pretransplant iron overload was correlated with transplantation outcome.