The impact of serum ceruloplasmin oxidase activity, glutathion level, oxidative stress parameters and iron overload on early transplant related complications and survival in allogeneic hematopoietic stem cell transplant recipients

Allogeneic hematopoietic stem cell transplantation has become a curative treatment for hematologic malignancies. Iron overload may have adverse impact on transplant outcomes among allogeneic HSCT recipients due to prior blood transfusions and ineffective eythropoiesis.We prospectively analyzed 70 consecutive alogeneic HSCT recipients and 20 healthy controls between June 2009 and January 2012. Serum samples both prior to conditioning regimen and stem cell infusion were analysed for iron parameters including ferritin, TS, and NTBI, MDA as prooxidant and SOA and GSH as antioxidants.Serum iron parameters were significantly higher in HSCT recipients compared to healthy controls. There was a significant increase in iron parameters prior to stem cell infusion compared to preconditioning serum samples. There was no significant change in serum MDA levels both between healthy controls and HSCT recipientsand between preconditioning and preinfusion serum samples. Serum COA levels were significantly higher in HSCT recipients compared to healthy controls. With the effect of conditioning regimen serum levels of ferritin, NTBI and GSH increased and COA decreased significantly. There were no correlation between serum levels of COA, GSH, MDA and iron parameters. Preconditioning serum ESR and CRP levels were significantly higher in patients with serum ferritin levels > 1000 ng/ml which might have role in increased serum ferritin levels as an acute phase reactant.An adverse impact of high serum ferritin levels on hepatotoxicity, cardiotoxicity, number of febrile and neutropenic days and neutrophil engraftment day was shown. Higher NTBI levels prior tos tem cell infusion had significant impact on infectious complications. Serum prooxidant/antioxidant parameters did not show any impact on transplantation related toxicities.Serum TS > 80 % and EBMT risc score ? 3 were independent adverse prognostic parameters for decreased overall survival and increased transplant related mortalityon day +100.In conclusion although pretransplantation IO was shown to be an adverse prognostic parameter on outcome of HSCT recipients, we could not be able to show any effect of prooxidative/antioxidative parameters. Further prospective studies including homogenous patient groups with same risk factors are needed to demostrate the role of oxidative stresson transplant outcomes in patients with iron overload.