scholarly journals Prognostic Impact of Posttransplantation Iron Overload after Allogeneic Stem Cell Transplantation

2013 ◽  
Vol 19 (3) ◽  
pp. 440-444 ◽  
Author(s):  
Sara C. Meyer ◽  
Alix O’Meara ◽  
Andreas S. Buser ◽  
André Tichelli ◽  
Jakob R. Passweg ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Iron Overload ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Prognostic Impact

CMV serostatus still has an important prognostic impact in de novo acute leukemia patients after allogeneic stem cell transplantation: a report from the Acute Leukemia Working Party of EBMT

Blood ◽  
2013 ◽  
Vol 122 (19) ◽  
pp. 3359-3364 ◽  
Author(s):  
Martin Schmidt-Hieber ◽  
Myriam Labopin ◽  
Dietrich Beelen ◽  
Liisa Volin ◽  
Gerhard Ehninger ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Acute Leukemia ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
De Novo ◽  
Working Party ◽  
Prognostic Impact ◽  
Key Points

Key Points Donor and/or recipient CMV seropositivity is still associated with an adverse prognosis in de novo acute leukemia patients after allo-SCT.

Prognostic Impact of Elevated Serum Ferritin in Patients Undergoing Myeloablative Stem Cell Transplantation.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 595-595 ◽  
Author(s):  
Philippe Armand ◽  
Corey S. Cutler ◽  
Haesook T. Kim ◽  
Vincent T. Ho ◽  
John Koreth ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Iron Overload ◽  
Cell Transplantation ◽  
Serum Ferritin ◽  
Ferritin Level ◽  
Elevated Serum ◽  
Albumin Level ◽  
Prognostic Impact ◽  
Disease Free

Abstract Patients undergoing allogeneic stem cell transplantation (alloSCT) for hematologic malignancies are often highly transfused, and thus at risk for transfusion-associated iron overload. In other settings, such as thalassemia or hemochromatosis, iron overload has been associated with organ toxicity, particularly hepatotoxicity, as well as with an increased susceptibility to infection. Since hepatic and infectious complications are frequent and life-threatening in patients undergoing alloSCT, iron overload could potentially be an important contributor to treatment-related morbidity and mortality after transplantation. We studied 935 consecutive patients who underwent myeloablative alloSCT at our institution between 1997 and 2005. A pre-transplant serum ferritin level, which we used as a surrogate measure of iron load, was available for 600 of the 935 patients (64%). The median ferritin level was 864ng/ml. The percentage of patients with serum ferritin ≥1000ng/ml was 47%. This percentage varied significantly between disease types, being lowest (6%) in patients with CML and highest (79%) in patients with AML. A ferritin level ≥1000ng/ml was associated with significantly worse overall and disease-free survival, as shown in the figure. Figure Figure This was confirmed in proportional hazards models using the following covariates: age, type and stage of disease, cytogenetic risk group for AML and MDS, conditioning regimen, HLA match, graft source, GVHD prophylaxis regimen, CMV serostatus, gender, prior transplant, and year of transplantation. In this model, the hazard ratio for mortality associated with ferritin ≥1000ng/ml was 1.7 (95%CI=1.3 to 2.4, p=0.0005). In competing risks regression analysis, using the same covariates, an elevated serum ferritin was associated with a significant increase in non-relapse mortality (NRM) (HR=1.6, p=0.02), but not with a significant increase in the risk of relapse. The greatest impact of elevated serum ferritin on survival and NRM was in patients with MDS (HR for mortality=3.0, p=0.001). Because serum ferritin is an acute phase reactant, we performed the same analyses using pre-transplant albumin level as an additional covariate that could reflect general inflammatory state. Although albumin level was of independent prognostic significance, its inclusion in the multivariate models did not alter the conclusions. Finally, in logistic regression analyses, elevated serum ferritin was associated with a non-significant increase in the risk of veno-occlusive disease (OR=1.6, p=0.09), but not in an increased risk of acute GVHD (OR=0.9, p=0.4) or specifically of acute liver GVHD (OR=1.2, p=0.5). Conclusions: in patients undergoing myeloablative alloSCT, and particularly in those with MDS, an elevated serum ferritin is associated with significantly higher NRM, as well as significantly lower disease-free and overall-survival. Our results could be helpful in estimating prognosis for patients who are candidates for myeloablative alloSCT. They also pave the way for prospective trials on the impact of iron overload and on the possible beneficial role of iron chelation in this patient population.

scholarly journals Gradually-Deteriorating Liver Function due to Iron Overload Over Four Years after Allogeneic Stem Cell Transplantation

2015 ◽  
Vol 55 (2) ◽  
pp. 109-112
Author(s):  
Hiroaki Tanaka ◽  
Chika Kawajiri ◽  
Shio Sakai ◽  
Yusuke Takeda ◽  
Takeharu Kawaguchi ◽  
...  
Keyword(s):  
Stem Cell ◽  
Liver Function ◽  
Stem Cell Transplantation ◽  
Iron Overload ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation

scholarly journals Prognostic Impact of Adverse Chromosomal Abnormalities on Outcome of Allogeneic Stem Cell Transplantation in Hyperdiploid Variant of Acute Myeloid Leukemia

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5234-5234
Author(s):  
Tatiana L Gindina ◽  
Mamaev N Nikolay ◽  
Bondarenko N Sergey ◽  
Slesarchuk A Olga ◽  
Anastasiya S Borovkova ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Chromosomal Abnormalities ◽  
Clinical Status ◽  
Prognostic Impact ◽  
Modal Number ◽  
Free Survival

Abstract Background. Chromosome gain is frequent in acute myeloid leukemia (AML) and is counted alongside structural abnormalities when determining karyotype complexity. Meantime, there are no studies investigating the cytogenetic profile and outcome of patients with a hyperdiploid variant (HV, ³47 chromosomes) of AML after allogeneic stem cell transplantation (allo-HSCT). Aim. To evaluate the prognostic impact of different cytogenetic characteristics, including the modal number, the number of chromosomal aberrations in complex karyotype (CK), the adverse chromosomal abnormalities (ACA) (monosomy 7/7q-, monosomy 5/5q-, monosomy 17/17p-,t(6;9)(p22;q34) on results of allogeneic stem cell transplantation (allo-HSCT) in patients with HV of AML. Material and methods.Forty-seven patients with HV of AML (21 women and 26 men, aged from 1 to 58 years, median - 23,9 years) were examined.Analysis of overall and event-free survival predictors after allo-HSCT in patients with different clinical, transplant and cytogenetic characteristics was performed. Results. The most common in the karyotype was the modal number of chromosome (MN) 47-48 which was observed in 31 (66 %) patients.Highhyperdiploidy with the modal number 49-65 wasidentified in13 (28 %) patients, near-triploidy and near-tetraploidy karyotypes were found in3 (6%) patients. Chromosomes were gained in a nonrandom pattern. Chromosome 8 (50 %), 21 (32 %), 13 (16 %)è 22 (16 %) were the most commonly gained. Structural chromosomal abnormalities were detected in 22 (47 %) patients, and the adverse chromosomal abnormalities were revealed in 7 (19 %) patients.In univariate analysis, overall survival (OS) and event-free survival (EFS) were various in patients with differentdisease status at transplantation (remission vs active disease; p=0.003 and p=0.002, respectively) and adverse chromosomal abnormalities inhyperdiploid karyotype (ACA- vs ACA+; p=0.001 and p=0.03, respectively). Additional analysis of selected patients group with structurally complex karyotype (n=19) showedthat the patients without ACA had OS higher than patients with ACA (p=0.03).In multivariate analysis, independent predictors of decreased OS and EFS were active disease at allo-HSCT (p=0.004èp=0.006, respectively) and the presence of the ACA (p=0.002 only for OS). Conclusion. High-risk factors in patients with HV of AML treated by allo-HSCT are adverse chromosomal aberrations. Therefore, the patients with formal criteria Çcomplex karyotypeÈ should not automatically be assigned to the adverse cytogenetic risk group on the basis of complexity. Instead they should be assessed for the presence of specific chromosomal abnormalities, which are known to harbor an adverse effect. Table 1 Patients and Transplant characteristics Table 1. Patients and Transplant characteristics Table 2 Multivariate analyses Table 2. Multivariate analyses Figure Overall survival depending on clinical status at HSCT and the presence of adverse chromosomal abnormalities (-7/7q-,5q-,17p-,t(6;9) in patients with a hyperdiploid variant of AML. Figure. Overall survival depending on clinical status at HSCT and the presence of adverse chromosomal abnormalities (-7/7q-,5q-,17p-,t(6;9) in patients with a hyperdiploid variant of AML. Disclosures No relevant conflicts of interest to declare.

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