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

Leuk Lymphoma. 2009 Oct;50(10):1566-72. doi: 10.1080/10428190903144659.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anemia / etiology
  • Anemia / therapy
  • Animals
  • Apoptosis
  • Chelation Therapy
  • Diagnosis, Differential
  • Erythrocyte Transfusion / adverse effects
  • Graft vs Host Disease / diagnosis
  • Graft vs Host Disease / etiology*
  • Graft vs Host Disease / physiopathology
  • Graft vs Host Disease / prevention & control
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Humans
  • Infections / etiology
  • Intestinal Absorption
  • Iron Overload / diagnosis
  • Iron Overload / drug therapy
  • Iron Overload / etiology*
  • Iron Overload / therapy
  • Iron, Dietary / pharmacokinetics
  • Liver / metabolism
  • Liver / pathology
  • Mice
  • Mice, Inbred Strains
  • Mice, SCID
  • Myelodysplastic Syndromes / blood
  • Myelodysplastic Syndromes / complications
  • Myelodysplastic Syndromes / surgery
  • Phlebotomy
  • Postoperative Complications / diagnosis
  • Postoperative Complications / drug therapy
  • Postoperative Complications / etiology*
  • Postoperative Complications / therapy
  • Transferrin / metabolism
  • Transferrin / therapeutic use
  • Transplantation Conditioning / adverse effects


  • Iron, Dietary
  • Transferrin