Abstract: Prognosis of Elevated Serum Ferritin in Allogeneic-HCT

Mostafa Shaheen, I.S. Moiseev, M.O. Ivanova, S.V. Bondarchuk, A.B. Chukhlovin and Boris V. Afanasyev

Introduction: Serum ferritin was demonstrated to be a useful tool to predict the risk in patients who undergo hematopoietic stem cell transplantation (HCT). Still it is not clear if its predictive value solely represents iron overload (IO) and published results are sometimes contradictory. So the objective of present study was to determine relationship between elevated pre-HCT serum ferritin levels, morbidity and mortality after allogeneic hematopoietic stem cell transplantation (allo-HCT) on one side, and its correlations with various risk indexes which were developed recently to predict outcomes after allo-HCT on the other side.
Patients and Methods: In this retrospective study we have reviewed medical records of one hundred six consecutive patients (52 males and 54 females), with a median age of 32 years (range, 5 to 60), who underwent allo-HCT with unmanipulated grafts between Jan 2013 and Dec2014. We retrieved pre-allo-HCT serum ferritin levels and also calculated risk indexes before HCT. The incidence of complications and outcomes after allo-HCT was assessed. The median follow-up period was 12 (range, 4-27) months after allo-HCT.
Results: We have determined a cuttoff ferritin level of 500 ng/mL for early complications and 737 for outcomes. We found increased incidence of number of febrile neutropenic episodes (P =0.02), number of bacterial infection episodes (P =0.009), pneumonias (P =0.039), slower period of neutrophil engraftment (P=0.032), demand for multiple red blood cell (RBC) transfusions (P =0.002) within 100 days post transplantation. A significant association was found between pre-transplant ferritin concentrations and different risk indexes; European Group for Blood and Marrow Transplantation (EBMT) risk score (P=0.001), Hematopoietic cell transplantation comorbidity index (HCT-CI) (P=0.003), Pre-transplant Assessment of Mortality (PAM) score (P=0.007) and disease risk (DR) (P =0.037).
Conclusion: On the one hand we did confirmed that even moderate serum ferritin elevation is associated with increased incidence of infections, slower period to engraftment and increasing demand of RBC units transfusions, but strong correlation with pre-transplant indexes that take into account disease risk raises the question if IO is the only factor that adversely affect the outcome of HCT in patients with increased ferritin. This should be studied in prospective trials.