Effect of pre-transplantation iron overload on the outcomes of allogeneic hematopoietic stem cell transplantation patients with non-hepatitis-related severe aplastic anemia

Objective To explore the effect of iron overload on the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients with non-hepatitis related severe aplastic anemia (SAA). Methods The clinical data were retrospectively analyzed for 98 patients with non-hepatitis related SAA undergoing allo-HSCT from July 2012 to late July 2018 at a single center. Serum ferritin (SF) was measured within 2 months before HSCT. They were divided into iron overload (SF>800.0 ng/ml, n=49) and control (SF<800.0 ng/ml, n=49) groups according to SF level. Overall survival (OS), hematopoietic reconstitution and common complications after allo-HSCT were analyzed. Results The median pre-transplantation SF value was 798.7(52.0-11060.0l) ng/ml. Patients with pre-transplantation iron overload had a higher incidence of cytomegaloviremia (P=0.041), delayed recovery of neutrophil/platelet (P=0.001, P=0.005 respectively) and transfusion-dependence in donor-recipient blood group-matched patients (P=0.043) after allo-HSCT. The 3-year OS was (65.1±7.1) % in iron overload group and (93.3±3.7) % in control group (P=0.001). Multivariate analysis indicated that 3-year OS was independently correlated with pre-transplantation iron overload (P=0.022), blood group of donor & recipient (P=0.015), early bacteremia (P=0.003) and cytomegaloviremia (P=0.003). Conclusions Iron overload is common in patients with non-hepatitis-related SAA before transplantation. Pre-transplantation iron overload has a significant impact on OS, hematopoietic reconstitution and cytomegaloviremia after allo-HSCT. Key words: Allogeneic hematopoietic stem cell transplantation; Ferritin; Aplastic anemia; Survival rate