Impact of initial serum ferritin on early post-HSCT complications: A single-center study

Abstract

Introduction Iron overload (IO) is an important issue when treating patients who undergo hematopoietic stem cell transplantation (HCT). Elevated pre-transplant serum ferritin levels have been associated with increased morbidity and mortality after allogeneic HCT. Patients and Methods In the single-center study, we have reviewed medical records of ninety-one consecutive patients (42 males and 49 females), with a median age at HCT of 31.6 years (range, 5 to 60), who underwent allo-HCT with unmanipulated grafts between Jan 2013 and Dec 2014. Results The median pre-HCT serum ferritin concentration was 765.35 (range, 12.1-4247) ng/mL for the total group. Fifty-three patients (58.24%) had initial serum ferritin of >500 ng/mL, and were assigned to the high-ferritin group. Increased pre-transplant ferritin concentrations were significantly associated with toxic or infectious complications of HCT, i.e., number of febrile neutropenic episodes (P=0.005), number of bacterial infection episodes (P=0.009), pneumonias (P=0.04), and demand for multiple RBC transfusions (P=0.04) within 100 days post-HCT. The significant association was found between pre-HCT ferritin concentrations (>773 ng/mL) and overall survival (P=0.04), disease-free survival (P=0.019), and mortality (P=0.02) among the groups. No significant relationships were observed between the initial ferritin levels and incidence of mucositis, or graftversus- host disease (P>0.05). Conclusion Measurement of serum ferritin, as a surrogate laboratory marker for IO, is quite practical for many hematological clinics. In the present study it was shown that the baseline increase of serum ferritin contents, is associated with higher risk of febrile episodes, infectious conditions, and slower recovery of myeloid cells, thus being of certain predictive value. Of special interest is an association between the pre-transplant ferritin levels and increasing demand for RBC transfusions after allo-HCT.