Iron Overload in Allogeneic Hematopoietic Cell Transplantation Outcome: A Meta-Analysis

Philippe Armand; Haesook T. Kim; Johanna M. Virtanen; Riitta K. Parkkola; Maija A. Itälä-Remes; Navneet S. Majhail; Linda J. Burns; Todd DeFor; Bryan Trottier; Uwe Platzbecker; Joseph H. Antin; Martin Wermke

doi:10.1016/j.bbmt.2014.04.024

Iron Overload in Allogeneic Hematopoietic Cell Transplantation Outcome: A Meta-Analysis

Philippe Armand, Haesook T. Kim, Johanna M. Virtanen, Riitta K. Parkkola, Maija A. Itälä-Remes, Navneet S. Majhail, Linda J. Burns, Todd DeFor, Bryan Trottier, Uwe Platzbecker, Joseph H. Antin, Martin Wermke

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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 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.

Original language	English (US)
Pages (from-to)	1248-1251
Number of pages	4
Journal	Biology of Blood and Marrow Transplantation
Volume	20
Issue number	8
DOIs	https://doi.org/10.1016/j.bbmt.2014.04.024
State	Published - Aug 2014

Bibliographical note

Funding 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 .

Keywords

Allogeneic hematopoietic cell transplantation
Iron overload
Serum ferritin

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Armand, P., Kim, H. T., Virtanen, J. M., Parkkola, R. K., Itälä-Remes, M. A., Majhail, N. S., Burns, L. J., DeFor, T., Trottier, B., Platzbecker, U., Antin, J. H., & Wermke, M. (2014). Iron Overload in Allogeneic Hematopoietic Cell Transplantation Outcome: A Meta-Analysis. Biology of Blood and Marrow Transplantation, 20(8), 1248-1251. https://doi.org/10.1016/j.bbmt.2014.04.024

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title = "Iron Overload in Allogeneic Hematopoietic Cell Transplantation Outcome: A Meta-Analysis",

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 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.",

keywords = "Allogeneic hematopoietic cell transplantation, Iron overload, Serum ferritin",

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note = "Funding 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 . ",

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AU - Armand, Philippe

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AU - Virtanen, Johanna M.

AU - Parkkola, Riitta K.

AU - Itälä-Remes, Maija A.

AU - Majhail, Navneet S.

AU - Burns, Linda J.

AU - DeFor, Todd

AU - Trottier, Bryan

AU - Platzbecker, Uwe

AU - Antin, Joseph H.

AU - Wermke, Martin

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N2 - 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.

AB - 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.

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Iron Overload in Allogeneic Hematopoietic Cell Transplantation Outcome: A Meta-Analysis

Abstract

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Keywords

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