Prevalence and risk factors of iron overload after hematopoietic stem cell transplantation for childhood acute leukemia: a LEA study

• Published in: Bone marrow transplantation (Basingstoke) Vol. 52; no. 1; pp. 80 - 87
• Main Authors: Sirvent, A, Auquier, P, Oudin, C, Bertrand, Y, Bohrer, S, Chastagner, P, Poirée, M, Kanold, J, Thouvenin, S, Perel, Y, Plantaz, D, Tabone, M-D, Yakouben, K, Gandemer, V, Lutz, P, Sirvent, N, Vercasson, C, Berbis, J, Chambost, H, Leverger, G, Baruchel, A, Michel, G
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.01.2017; Nature Publishing Group
• Subjects: 692/499; 692/700/784; Acute leukemia; Age Factors; Allografts; Analysis; Bone marrow; Cancer; Cancer Survivors; Care and treatment; Cell Biology; Child; Diagnosis; Erythrocyte sedimentation rate; Female; Ferritins - blood; Graft vs Host Disease - blood; Graft vs Host Disease - epidemiology; Hematology; Hematopoietic Stem Cell Transplantation; Human health and pathology; Humans; Immunology; Internal Medicine; Iron Overload - blood; Iron Overload - epidemiology; Leukemia, Myeloid, Acute - blood; Leukemia, Myeloid, Acute - epidemiology; Leukemia, Myeloid, Acute - therapy; Life Sciences; Male; Medicine; Medicine & Public Health; original-article; Precursor Cell Lymphoblastic Leukemia-Lymphoma - blood; Precursor Cell Lymphoblastic Leukemia-Lymphoma - epidemiology; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Prevalence; Public Health; Quality of life; Risk Factors; Stem cell transplantation; Stem Cells; Tissue Donors; Transplantation Conditioning
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2016.205

Data on post-transplant iron overload (IO) are scarce in pediatrics. We conducted a prospective multicenter cohort study (Leucémie de l’Enfant et de l’Adolescent cohort) to determine the prevalence and risk factors of IO in 384 acute leukemia survivors transplanted during childhood. Prevalence of IO (ferritin level ⩾350 ng/mL) was 42.2% (95%CI 37.2–47.2%). Factors significantly associated with IO were: 1) in univariate analysis: older age at transplant ( P <0.001), allogeneic versus autologous transplantation ( P <0.001), radiation-based preparative regimen ( P =0.035) and recent period of transplantation ( P <0.001); 2) in multivariate analysis: older age at transplant in quartiles (Odds Ratio (OR)=7.64, 95% CI: 3.73–15.64 for age >12.7 years and OR=5.36, 95% CI: 2.63–10.95 for age from 8.2 to 12.7 years compared to age < 4.7 years), acute myeloid leukemia (OR=3.23, 95% CI: 1.47–7.13), allogeneic graft (OR=4.34, 95% CI: 2.07–9.12 for alternative donors and OR=2.53, 95% CI: 1.2–5.33 for siblings, compared to autologous graft) and radiation-based conditioning regimen (OR=2.45, 95% CI: 1.09–5.53). Graft- versus -host disease was an additional risk factor for allogeneic graft recipients. In conclusion, IO is a frequent complication in pediatric long-term survivors after transplantation for acute leukemia, more frequently observed in older children, those transplanted from alternative donors or with graft- versus -host disease.