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Biol Blood Marrow Transplant. 2014 Aug;20(8):1248-51. doi: 10.1016/j.bbmt.2014.04.024. Epub 2014 Apr 24.

Iron overload in allogeneic hematopoietic cell transplantation outcome: a meta-analysis.

Author information

1
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. Electronic address: parmand@partners.org.
2
Department Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts.
3
Department of Radiology, Turku University Hospital, Turku, Finland.
4
Department of Medicine, Turku University Hospital, Turku, Finland.
5
Department of Blood and Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
6
Department of Medicine, Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
7
Biostatistics Core, Masonic Cancer Center, University of Minnesota Medical School, Minneapolis, Minnesota.
8
Department of Medicine I, University Hospital C.-G.-Carus, Dresden, Germany.
9
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.

Abstract

An elevated ferritin level before allogeneic hematopoietic cell transplantation (HCT) is an adverse prognostic factor for overall survival (OS) and nonrelapse mortality. Because ferritin is an imperfect surrogate of iron stores, the prognostic role of iron overload remains unclear. We conducted a patient-level meta-analysis of 4 studies that used magnetic resonance imaging to estimate pre-HCT liver iron content (LIC). An elevated LIC was not associated with a significant increase in mortality: the hazard ratio (HR) for mortality associated with LIC > 7 mg/g dry weight (primary endpoint) was 1.4 (P = .18). In contrast, ferritin >1000 ng/mL was a significant prognostic factor (HR for mortality, 1.7; P = .036). There was, however, no significant association between ferritin > 2500 and mortality. This meta-analysis suggests that iron overload, as assessed by LIC, is not a strong prognostic factor for OS in a general adult HCT population. Our data also suggest that ferritin is an inadequate surrogate for iron overload in HCT.

KEYWORDS:

Allogeneic hematopoietic cell transplantation; Iron overload; Serum ferritin

PMID:
24769316
PMCID:
PMC4099413
DOI:
10.1016/j.bbmt.2014.04.024
[Indexed for MEDLINE]
Free PMC Article
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