Clinical Research Papers:
MRI-based evaluation of multiorgan iron overload is a predictor of adverse outcomes in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation
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Natalia Maximova1, Massimo Gregori2, Giulia Boz3, Roberto Simeone4, Davide Zanon5, Giulia Schillani1 and Floriana Zennaro2
1Bone Marrow Transplant Unit, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, 34137 Trieste, Italy
2Department of Radiology, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, 34137 Trieste, Italy
3University of Trieste, Piazzale Europa, 34128 Trieste, Italy
4Department of Transfusion Medicine, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, 34137 Trieste, Italy
5Pharmacy, Institute for Maternal and Child Health–IRCCS Burlo Garofolo, 34137 Trieste, Italy
Natalia Maximova, email: [email protected]
Keywords: multiorgan iron overload, pediatric patients, allogeneic hematopoietic stem cell transplantation, transplant-related complications
Received: November 04, 2016 Accepted: June 19, 2017 Published: July 05, 2017
The medical records of 44 pediatric patients who underwent allogeneic transplantation from 2011 to 2015 were retrospectively reviewed. Magnetic resonance imaging was used to measure iron concentrations in the liver, spleen, pancreas and bone. These patients were divided into two groups, 18 with non-elevated (< 100 μmol/g; Group 1) liver iron concentration before transplantation and 26 with elevated (> 100 μmol/g; Group 2) concentration . We compared transplant-related outcomes in the two groups. Iron overload was a negative prognostic risk factor for sinusoidal obstruction syndrome (OR = 17), osteoporosis (OR = 6.8), pancreatic insufficiency (OR = 17) and metabolic syndrome (OR = 15.1). No statistically significant differences in overall survival, disease-free survival, relapse incidence and incidence of acute or chronic graft-versus host disease were observed between the two groups. Mean times to engraftment of platelets (43.0 ± 35.3 days vs. 22.1 ± 9.5 days, p < 0.05) and neutrophils (23.1 ± 10.4 days vs. 17.8 ± 4.6 days, p < 0.05) appear significantly longer in Group 2 than in Group 1. Time to platelet engraftment showed statistically significant correlation with pre-transplant liver (r = 0.5775; p < 0.001) and bone iron concentration (r = 0.7305; p < 0.001). Post-transplant evaluation pointed out that iron concentration analyzed at the first follow-up peaked in all tissues. The iron accumulation was highest in bone, followed by the spleen, liver and pancreas. One year post transplant 9 of 18 (50%) patients in Group 1 and 6 of 22 (27%) in Group 2 presented with bone and/or spleen iron overload, but not with liver overload. Liver iron concentration is not always a reliable indicator of systemic siderosis or of the efficacy of chelation therapy.
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