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 4studies 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>7mg/g dry weight (primary endpoint) was 1.4 (P= .18). In contrast, ferritin >1000ng/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.
Bibliographical noteFunding Information:
Financial disclosure : P.A. was supported by an ASCO Career Development Award. This work was also supported by National Institute of Allergy and Infectious Diseases U19 AI 29530 , NCI P01 CA142106 , and the Jock and Bunny Adams Research and Education Endowment .
- Allogeneic hematopoietic cell transplantation
- Iron overload
- Serum ferritin