Iron Overload during Follow-up after Tandem High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Patients with High-Risk Neuroblastoma.
10.3346/jkms.2012.27.4.363
- Author:
Soo Jin BAE
1
;
Christine KANG
;
Ki Woong SUNG
;
Hee Won CHUEH
;
Meong Hi SON
;
Soo Hyun LEE
;
Keon Hee YOO
;
Hong Hoe KOO
Author Information
1. Faculty of Human Medicine, Hannover Medical School, Hannover, Germany.
- Publication Type:Original Article
- Keywords:
High-Dose Chemotherapy;
Autologous Stem Cell Transplantation;
Iron Overload;
Deferasirox;
Iron Chelation Treatment;
Neuroblastoma
- MeSH:
Antigens, CD34/metabolism;
Antineoplastic Combined Chemotherapy Protocols/*therapeutic use;
Benzoic Acids/therapeutic use;
Blood Transfusion/*adverse effects;
Child;
Child, Preschool;
Creatinine/blood;
Ferritins/blood;
Follow-Up Studies;
Humans;
Infant;
Iron Chelating Agents/therapeutic use;
Iron Overload/*etiology;
Neuroblastoma/drug therapy/*therapy;
Retrospective Studies;
Risk Factors;
*Stem Cell Transplantation;
Transplantation, Autologous;
Triazoles/therapeutic use
- From:Journal of Korean Medical Science
2012;27(4):363-369
- CountryRepublic of Korea
- Language:English
-
Abstract:
Multiple RBC transfusions inevitably lead to a state of iron overload before and after high-dose chemotherapy and autologous stem cell transplantation (HDCT/autoSCT). Nonetheless, iron status during post-SCT follow-up remains unknown. Therefore, we investigated post-SCT ferritin levels, factors contributing to its sustained levels, and organ functions affected by iron overload in 49 children with high-risk neuroblastoma who underwent tandem HDCT/autoSCT. Although serum ferritin levels gradually decreased during post-SCT follow-up, 47.7% of the patients maintained ferritin levels above 1,000 ng/mL at 1 yr after the second HDCT/autoSCT. These patients had higher serum creatinine (0.62 vs 0.47 mg/mL, P = 0.007) than their counterparts (< 1,000 ng/mL). Post-SCT transfusion amount corresponded to increased ferritin levels at 1 yr after the second HDCT/autoSCT (P < 0.001). A lower CD34+ cell count was associated with a greater need of RBC transfusion, which in turn led to a higher serum ferritin level at 1 yr after HDCT/autoSCT. The number of CD34+ cells transplanted was an independent factor for ferritin levels at 1 yr after the second HDCT/autoSCT (P = 0.019). Consequently, CD34+ cells should be transplanted as many as possible to prevent the sustained iron overload after tandem HDCT/autoSCT and consequent adverse effects.
