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. 2020 Apr 15;11:586.
doi: 10.3389/fimmu.2020.00586. eCollection 2020.

Association of Serum Ferritin Levels Before Start of Conditioning With Mortality After alloSCT - A Prospective, Non-interventional Study of the EBMT Transplant Complications Working Party

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Free PMC article

Association of Serum Ferritin Levels Before Start of Conditioning With Mortality After alloSCT - A Prospective, Non-interventional Study of the EBMT Transplant Complications Working Party

Olaf Penack et al. Front Immunol. .
Free PMC article

Abstract

Elevated serum ferritin levels occur due to iron overload or during inflammation and macrophage activation. A correlation of high serum ferritin levels with increased mortality after alloSCT has been suggested by several retrospective analyses as well as by two smaller prospective studies. This prospective multicentric study aimed to study the association of ferritin serum levels before start of conditioning with alloSCT outcome. Patients with acute leukemia, lymphoma or MDS receiving a matched sibling alloSCT for the first time were considered for inclusion, regardless of conditioning. A comparison of outcomes between patients with high and low ferritin level was performed using univariate analysis and multivariate analysis using cause-specific Cox model. Twenty centers reported data on 298 alloSCT recipients. The ferritin cut off point was determined at 1500 μg/l (median of measured ferritin levels). In alloSCT recipients with ferritin levels above cut off measured before the start of conditioning, overall survival (HR = 2.5, CI = 1.5-4.1, p = 0.0005) and progression-free survival (HR = 2.4, CI = 1.6-3.8, p < 0.0001) were inferior. Excess mortality in the high ferritin group was due to both higher relapse incidence (HR = 2.2, CI = 1.2-3.8, p = 0.007) and increased non-relapse mortality (NRM) (HR = 3.1, CI = 1.5-6.4, p = 0.002). NRM was driven by significantly higher infection-related mortality in the high ferritin group (HR = 3.9, CI = 1.6-9.7, p = 0.003). Acute and chronic GVHD incidence or severity were not associated to serum ferritin levels. We conclude that ferritin levels can serve as routine laboratory biomarker for mortality risk assessment before alloSCT.

Keywords: biomarker; ferritin; immunology; iron metabolism; stem cell; transplantation.

Figures

FIGURE 1
FIGURE 1
Survival after alloSCT in both cohorts according to ferritin serum levels prior to alloSCT. Overall survival (OS) (A) as well as progression free survival (PFS) (B) were significantly inferior in patients with high ferritin serum levels (blue line) as compared to patients with low ferritin levels (red line).
FIGURE 2
FIGURE 2
Relapse incidence (RI) after alloSCT in both cohorts according to ferritin serum levels prior to alloSCT. Relapse incidence was increased in patients with high ferritin serum levels (blue line) as compared to patients with low ferritin levels (red line).
FIGURE 3
FIGURE 3
Non-relapse mortality (NRM) after alloSCT in both cohorts according to ferritin serum levels prior to alloSCT. NRM was increased in patients with high ferritin serum levels (blue line) as compared to patients with low ferritin levels (red line).
FIGURE 4
FIGURE 4
Infection-related mortality after alloSCT in both cohorts according to ferritin serum levels prior to alloSCT. Infection-related mortality was increased in patients with high ferritin serum levels (blue line) as compared to patients with low ferritin levels (red line).

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References

    1. Gratwohl A, Hermans J, Goldman JM, Arcese W, Carreras E, Devergie A, et al. Risk assessment for patients with chronic myeloid leukaemia before allogeneic blood or marrow transplantation. chronic leukemia working party of the european group for blood and marrow transplantation. Lancet. (1998) 352:1087–92. - PubMed
    1. Sorror ML, Sandmaier BM, Storer BE, Maris MB, Baron F, Maloney DG, et al. Comorbidity and disease status based risk stratification of outcomes among patients with acute myeloid leukemia or myelodysplasia receiving allogeneic hematopoietic cell transplantation. J Clin Oncol. (2007) 25:4246–54. - PubMed
    1. Armand P, Gibson CJ, Cutler C, Ho VT, Koreth J, Alyea EP, et al. risk index for patients undergoing allogeneic stem cell transplantation. Blood. (2012) 120:905–13. 10.1182/blood-2012-03-418202 - DOI - PMC - PubMed
    1. Elsawy M, Sorror ML. Up-to-date tools for risk assessment before allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. (2016) 51:1283–300. 10.1038/bmt.2016.141 - DOI - PubMed
    1. Rowan CM, Paczesny S. Biomarkers for early complications after hematopoietic stem cell transplantation. Clin Lab Med. (2019) 39:61–72. 10.1016/j.cll.2018.10.005 - DOI - PMC - PubMed
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