The relation of body iron load and nakil related complications in allogenic stem cell transplanted patients with acute leukemia and myelodysplasia

Body iron accumulation increases in malignancies due to intensive chemotherapy induced ineffective erythropoesisis, increased iron absorption in intestine, blood transfusions, and the effect of cytotoxic chemotherapy and radiotherapy. HSCT is a curative therapy option in treatment of malign hematologic diseases. Iron overload is so frequent that iron toxicity has significant influence on non relapse related mortality in both short and long terms of time. In this study we evaluated the effect of iron load on survival and complications during transplantation period and posttransplant follow up of acute leukemia and myelodysplasia patients. Sixty patients who had stem cell transplantation at Akdeniz University Pediatric Stem Cell Transplantation Unit in 2000-2012 were enrolled into study. Data were evaluated retrospectively. Pre-transplant serum ferritin levels were recorded as an indicator of body iron load. Mean ferritin level was 1299ng/ml, and patients were grouped into two according to this level. Forty-two patients were male (70%). In low ferritin group mean age was 85,43 (±9,42) months, whereas in high ferritin group the mean age was 118,56 (±10,04) months. The primary disease was ALL for 32 patients (53,3%), AML for 25 (38,4%) and MDS for 5 (8,3%). Among demographic data, sex, diagnosis, the number of remission, source of stem cell, donor, HLA match, and total body irradiation in induction therapy and ATG in GvHD prophylaxis were evaluated. None of these parameters were found to be significantly related with ferritin. In order to evaluate relation of ferritin level and transplantation complications, acute skin, liver and GIS GvHD were investigated. In high ferritin group acute GvHD was significantly higher (p<0.011). Engraftment syndrome, VOD, early or late infections and BOOP frequency were not statistically significant related with ferritin levels. Also relapse rate was not found to be related with ferritin level. Thirty patients (50%) of patients were alive and transplant related mortality was 40%. Three-year overall survival was 50,6 % ± 6,6, three-year disease free survival was 71,7% ± 6,5. Ferritin levels were not found to be associated with overall survival and disease free survival. Iron chelation therapy in stem cell transplantation candidate patients with hematologic malignancy seems to be not so necessary. There are many factors which may alter hepatic dysfunctions in post-HSCT period. Especially in patients with high ferritin levels, early immunosuppressive drug therapy should be considered in liver aGvHD. Therefore, our finding of increased acute hepatic GVHD risk in iron-overloaded patients remains to be confirmed in future large multicenter prospective studies prospective studies.