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

Research output: Contribution to journalArticle

49 Scopus citations

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 languageEnglish (US)
Pages (from-to)1248-1251
Number of pages4
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number8
DOIs
StatePublished - Aug 2014

Keywords

  • Allogeneic hematopoietic cell transplantation
  • Iron overload
  • Serum ferritin

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