Submitted October 27, 2006
Accepted January 14, 2007
Prognostic impact of elevated pre-transplant serum ferritin in patients undergoing myeloablative stem cell transplantation
Philippe Armand*, Haesook T Kim, Corey S Cutler, Vincent T Ho, John Koreth, Edwin P Alyea, Robert J Soiffer, and Joseph H Antin
Dept of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
Dept of Biostatistics, Dana-Farber Cancer Institute, Boston, MA, United States
* Corresponding author; email: parmand{at}partners.org.
Iron overload could be a significant contributor to treatment-related mortality (TRM) for patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT). We studied 590 patients who underwent myeloablative allogeneic HSCT at our institution, and on whom a pre-transplant serum ferritin was available. An elevated pre-transplant serum ferritin level was strongly associated with lower overall and disease-free survival. Subgroup multivariable analyses demonstrated that this association was restricted to patients with acute leukemia or myelodysplastic syndrome (MDS); in the latter group, the inferior survival was attributable to a significant increase in TRM. There was also a trend towards an increased risk of veno-occlusive disease in patients with high ferritin. Our results argue that iron overload plays an important role in transplantation outcome for patients with acute leukemia or MDS, as it does in thalassemia. They also suggest future prospective trials to examine the potential benefit of chelation therapy in this setting.
