Association between the pre-transplantation serum ferritin level and outcomes of hematopoietic stem cell transplantation: A systematic review and meta-analysis

• Published in: Heliyon Vol. 10; no. 18; p. e37436
• Main Authors: Pan, Wenjue, Teng, Qibei, Chen, Huiqiao, Hu, Liangning, Yue, Xiaoyan, Qian, Zijun, Dong, Ruoyu, Zhou, Hongyu, Zhao, Xiujie, Xiao, Haowen, Wang, Shufen
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 30.09.2024; Elsevier
• Subjects: CRD42023448899; Fungal infection; Hematopoietic stem cell transplantation; Meta-analysis; PROSPERO; Serum ferritin; PROSPERO; Serum ferritin; Hematopoietic stem cell transplantation; Fungal infection; CRD42023448899; Meta-analysis
• ISSN: 2405-8440; 2405-8440
• DOI: 10.1016/j.heliyon.2024.e37436

Iron overload, as indicated by evaluated serum ferritin (SF) level, occurs commonly in patients with hematological diseases. To evaluate the association between pre-transplant SF level and outcomes of hematopoietic stem cell transplantation (HSCT), we performed this systematic review and meta-analysis. PubMed, Embase, Web of Science and the Cochrane Library electronic database were searched from inception to August 2023, and 56 studies with 14149 patients were found to be eligible. An elevated pre-transplantation SF level was associated with inferior overall survival (hazard ratio [HR],1.77; 95 % confidence interval [CI],1.61–1.96) and disease-free survival (HR, 1.86; 95 % CI, 1.58–2.19), and increased risk of non-relapse mortality (HR, 1.73; 95 % CI, 1.49–2.02), and relapse (HR, 1.46; 95 % CI, 1.29–1.65). However, no meaningful association was observed between SF levels and acute graft-versus-host disease (GVHD) (risk ratio [RR], 1.09; 95 % CI, 0.96–1.24), or chronic GVHD (RR, 0.95; 95 % CI, 0.79–1.16). Furthermore, an elevated pre-transplantation SF level was associated with a higher risk of fungal infection (RR, 1.56; 95 % CI, 1.16–2.10), but not with bacterial infection (RR, 1.09; 95 % CI, 0.80–1.50). Moreover, an elevated pre-transplantation SF level was related to a higher risk of death due to relapse/disease progression (RR, 1.72; 95 % CI, 1.33–2.23) and infection (RR, 2.21; 95 % CI, 1.55–3.15), but not death due to GVHD (RR, 1.18; 95 % CI, 0.79–1.77). A higher pre-transplantation SF level was significantly associated with a higher risk of relapse/disease progression and infections, which contributed to worse survival in patients undergoing HSCT. In particular, a higher SF level was related to a higher risk of fungal infection, indicating that patients with a higher pre-transplantation SF level require more attention regarding the risk of fungal infection after HSCT. •Higher pre-transplant SF level was related to higher risk of death due to relapse/progression and infection, but not GVHD.•Higher pre-transplant SF level was associated with higher risk of fungal infection, but not with that of bacterial infection.•Higher pre-transplant SF level was associated with increased risk of hepatic sinusoidal obstruction syndrome.