Serum ferritin is not a reliable predictor to determine iron overload in thalassemia major patients post hematopoietic stem cell transplantation.

OBJECTIVE: Iron overload (IO) in transfusion-dependent anemia persists after hematopoietic stem cell transplantation (HSCT) and can cause long-term organ damage. In many studies, the diagnosis of IO before and after HSCT is based on serum ferritin (SF) levels rather than on assessment of liver iron concentration (LIC) by MRI or SQUID. METHOD: In a retrospective multicenter study, we analyzed the concordance for indication of iron depletion therapy and correlation between LIC and SF of 36 thalassemia patients after HSCT. LIC was determined either by MRI-R2 (FerriScan®) or SQUID. RESULTS: The concordance between LIC and SF varies over time after transplant (P = 0.011). The correlation between SF and LIC was strong in the first year (Spearman's rho 0.75; P  4th year, it was 58%, 60%, and 25%, respectively. CONCLUSIONS: Our data suggest serum ferritin is not a reliable predictor to determine iron overload in thalassemia patients after HSCT.