Iron overload, hematopoietic cell transplantation, and graft-versus-host disease.

Publication Type:

Journal Article

Source:

Leukemia & lymphoma, Volume 50, Issue 10, p.1566-72 (2009)

Keywords:

2009, Anemia, Animals, APOPTOSIS, Center-Authored Paper, Chelation Therapy, Clinical Research Division, Diagnosis, Differential, Erythrocyte Transfusion, Experimental Histopathology Core Facility, Graft vs Host Disease, hematopoietic stem cell transplantation, Humans, INFECTION, Intestinal Absorption, Iron Overload, Iron, Dietary, liver, MICE, Mice, Inbred Strains, Mice, SCID, Myelodysplastic Syndromes, Phlebotomy, Postoperative Complications, Shared Resources, Specialized Pathology Core Facility, Transferrin, Transplantation Conditioning

Abstract:

Many patients who undergo hematopoietic cell transplantation (HCT) present with anemia and have received red blood cell transfusions before HCT. As a result, iron overload is frequent and appears to be particularly prominent in patients with myelodysplastic syndromes. There is evidence that peritransplant events contribute to further iron accumulation, although the mechanism that disrupts normal iron homeostasis remains to be determined. Recent studies suggest that iron overload, as determined by ferritin levels, a surrogate marker for iron, is a risk factor for increased non-relapse mortality after HCT. Iron overload is associated with an increased rate of infections, in particular with fungal organisms. Furthermore anecdotal data suggest that increased hepatic iron may mimic the clinical picture of (chronic) graft-versus-host-disease (GVHD). Whether excess iron contributes to GVHD and whether iron depletion, be it by phlebotomy or chelation, reduces the post-transplantation complication rate and improves transplant outcome is yet to be determined.