Iron Overload in Patients Undergoing Hematopoietic Stem Cell Transplantation

Overview

Journal Adv Hematol

Publisher Wiley

Specialty Hematology

Date 2010 Sep 28

PMID 20871852

Citations 14

Authors

Vinod Pullarkat

Affiliations

Soon will be listed here.

Abstract

Recipients of hematopoietic stem cell transplantation (HSCT) frequently have iron overload resulting from chronic transfusion therapy for anemia. In some cases, for example, in patients with myelodysplastic syndromes and thalassemia, this can be further exacerbated by increased absorption of iron from the gut as a result of ineffective erythropoiesis. Accumulating evidence has established the negative impact of elevated pretransplantation serum ferritin, a surrogate marker of iron overload, on overall survival and nonrelapse mortality after HSCT. Complications of HSCT associated with iron overload include increased bacterial and fungal infections as well as sinusoidal obstruction syndrome and possibly other regimen-related toxicities. Based on current evidence, particular attention should be paid to prevention and management of iron overload in allogeneic HSCT candidates, especially in patients with thalassemia and myelodysplastic syndromes. The pathophysiology of iron overload in the HSCT patient and optimum strategies to deal with iron overload during and after HSCT require further study.

Citing Articles

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Longitudinal proteomics study of serum changes after allogeneic HSCT reveals potential markers of metabolic complications related to aGvHD.

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Deferasirox-Dependent Iron Chelation Enhances Mitochondrial Dysfunction and Restores p53 Signaling by Stabilization of p53 Family Members in Leukemic Cells.

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References

Wood J . Diagnosis and management of transfusion iron overload: the role of imaging. Am J Hematol. 2007; 82(12 Suppl):1132-5. PMC: 2892928. DOI: 10.1002/ajh.21099. View

Olivieri N . The beta-thalassemias. N Engl J Med. 1999; 341(2):99-109. DOI: 10.1056/NEJM199907083410207. View

Mahindra A, Bolwell B, Sobecks R, Rybicki L, Pohlman B, Dean R . Elevated pretransplant ferritin is associated with a lower incidence of chronic graft-versus-host disease and inferior survival after myeloablative allogeneic haematopoietic stem cell transplantation. Br J Haematol. 2009; 146(3):310-6. DOI: 10.1111/j.1365-2141.2009.07774.x. View

Kanda J, Mizumoto C, Kawabata H, Tsuchida H, Tomosugi N, Matsuo K . Serum hepcidin level and erythropoietic activity after hematopoietic stem cell transplantation. Haematologica. 2008; 93(10):1550-4. DOI: 10.3324/haematol.12399. View

Cabantchik Z, Breuer W, Zanninelli G, Cianciulli P . LPI-labile plasma iron in iron overload. Best Pract Res Clin Haematol. 2005; 18(2):277-87. DOI: 10.1016/j.beha.2004.10.003. View

Majhail N, Lazarus H, Burns L . Iron overload in hematopoietic cell transplantation. Bone Marrow Transplant. 2008; 41(12):997-1003. DOI: 10.1038/bmt.2008.99. View

Lucarelli G, Angelucci E, Giardini C, Baronciani D, Galimberti M, Polchi P . Fate of iron stores in thalassaemia after bone-marrow transplantation. Lancet. 1993; 342(8884):1388-91. DOI: 10.1016/0140-6736(93)92753-g. View

Sahlstedt L, Ebeling F, von Bonsdorff L, Parkkinen J, Ruutu T . Non-transferrin-bound iron during allogeneic stem cell transplantation. Br J Haematol. 2001; 113(3):836-8. DOI: 10.1046/j.1365-2141.2001.02820.x. View

CAROLINE L, Rosner F, Kozinn P . Elevated serum iron, low unbound transferrin and candidiasis in acute leukemia. Blood. 1969; 34(4):441-51. View

10.

Kornreich L, Horev G, Yaniv I, Stein J, Grunebaum M, Zaizov R . Iron overload following bone marrow transplantation in children: MR findings. Pediatr Radiol. 1998; 27(11):869-72. DOI: 10.1007/s002470050259. View

11.

Wells R, Leber B, Buckstein R, Lipton J, Hasegawa W, Grewal K . Iron overload in myelodysplastic syndromes: a Canadian consensus guideline. Leuk Res. 2008; 32(9):1338-53. DOI: 10.1016/j.leukres.2008.02.021. View

12.

Brittenham G, Cohen A, McLaren C, Martin M, Griffith P, Nienhuis A . Hepatic iron stores and plasma ferritin concentration in patients with sickle cell anemia and thalassemia major. Am J Hematol. 1993; 42(1):81-5. DOI: 10.1002/ajh.2830420116. View

13.

Rizzo J, Wingard J, Tichelli A, Lee S, Van Lint M, Burns L . Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation: joint recommendations of the European Group for Blood and Marrow Transplantation, Center for International Blood and Marrow Transplant.... Bone Marrow Transplant. 2006; 37(3):249-61. DOI: 10.1038/sj.bmt.1705243. View

14.

Bradley S, Gosriwitana I, Srichairatanakool S, Hider R, Porter J . Non-transferrin-bound iron induced by myeloablative chemotherapy. Br J Haematol. 1997; 99(2):337-43. DOI: 10.1046/j.1365-2141.1997.4143221.x. View

15.

Ibrahim A, Spellberg B, Edwards Jr J . Iron acquisition: a novel perspective on mucormycosis pathogenesis and treatment. Curr Opin Infect Dis. 2008; 21(6):620-5. PMC: 2773686. DOI: 10.1097/QCO.0b013e3283165fd1. View

16.

Chacko J, Pennell D, Tanner M, Hamblin T, Wonke B, Levy T . Myocardial iron loading by magnetic resonance imaging T2* in good prognostic myelodysplastic syndrome patients on long-term blood transfusions. Br J Haematol. 2007; 138(5):587-93. DOI: 10.1111/j.1365-2141.2007.06695.x. View

17.

Taher A, El Rassi F, Ismaeel H, Koussa S, Inati A, Cappellini M . Correlation of liver iron concentration determined by R2 magnetic resonance imaging with serum ferritin in patients with thalassemia intermedia. Haematologica. 2008; 93(10):1584-6. DOI: 10.3324/haematol.13098. View

18.

De la Serna J, Bornstein R, Garcia-Bueno M . Iron depletion by phlebotomy with recombinant erythropoietin prior to allogeneic transplantation to prevent liver toxicity. Bone Marrow Transplant. 1999; 23(1):95-7. DOI: 10.1038/sj.bmt.1701534. View

19.

Miceli M, Dong L, Grazziutti M, Fassas A, Thertulien R, van Rhee F . Iron overload is a major risk factor for severe infection after autologous stem cell transplantation: a study of 367 myeloma patients. Bone Marrow Transplant. 2006; 37(9):857-64. DOI: 10.1038/sj.bmt.1705340. View

20.

Angelucci E, Muretto P, Lucarelli G, Ripalti M, Baronciani D, Erer B . Phlebotomy to reduce iron overload in patients cured of thalassemia by bone marrow transplantation. Italian Cooperative Group for Phlebotomy Treatment of Transplanted Thalassemia Patients. Blood. 1997; 90(3):994-8. View