Effect Of Iron-chelating Therapy Before Allogeneic Hematopoietic Stem Cell Transplantation On The Outcome Of Transplantation In Iron Overload Patients With Severe Aplastic Anemia

Purpose To study the effect of iron overload on allogeneic hematopoietic stem cell transplantation(allo HSCT)in patients with severe aplastic anemia(SAA)and the effect of iron removal on prognosis.Methods The clinical data of 110 patients with severe aplastic anemia(SAA)from March 2012 to July 2019 were analyzed retrospectively.The patients were divided into three groups for comparison: group 1:9non iron overload),group 2(iron overload with serum ferritin(SF)> 1000 ng / ml),group 3(iron overload with SF level below1000 ng / ml after DFX treatment).Through the investigation and comparison,including total survival,transplantation related death,implantation after transplantation,transplantation related complications,as well as the condition of various organs,the differences of each group were compared by multiple statistical methods(single factor and multi factor analysis).This study conforms to the ethical standards formulated by the Chinese registered clinical trial ethics committee.Results The 100 day TRM of the two groups was significantly higher than that of the first group(g1:5.9%,g2:34.6%,P < 0.001).In addition,the 1-year overall survival rate(OS)(g1:84.8% vs g2:56.7%,P = 0.001)and neutrophil transplantation rate(g1:98.5% vs g2:80.8%,P = 0.038)were worse in group 2.Iron overload was anindependent risk for neutrophil transplantation,1-year OS rate and 100 day TRM(HR: 0.48,P = 0.006;HR: 4.23,P = 0.001 and HR: 6.78,P = 0.001).Compared with group 2,group 3 had lower TRM on 100 days(g2:34.6% vs g3:6.3%,P = 0.046)and higher OS rate in one year(g2:56.7% vs g3:93.7%,P = 0.022).In contrast,there was no significant difference in complications and survival rates between group 1 and group 3.Conclusion iron overload has a negative effect on transplantation.The adverse effect of DFX reversible iron overload on HSCT prognosis in SAA patients.