Total body irradiation and iron chelation treatment are associated with pancreatic injury following pediatric hematopoietic stem cell transplantation

// Natalia Maximova 1 , Massimo Gregori 2 , Roberto Simeone 3 , Aurelio Sonzogni 4 , Davide Zanon 5 , Giulia Boz 6 and Lorenzo D’Antiga 7 1 Bone Marrow Transplant Unit, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy 2 Department of Pediatric Radiology, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy 3 Department of Transfusion Medicine, Trieste University Hospital, Trieste, Italy 4 Department of Pathology, Hospital Papa Giovanni XXIII, Bergamo, Italy 5 Pharmacy, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy 6 Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy 7 Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy Correspondence to: Natalia Maximova, email: natalia.maximova@burlo.trieste.it Keywords: allogeneic HSCT; pediatric patients; acute pancreatic iron overload; exocrine pancreatic dysfunction; pancreatic shrinkage Received: October 31, 2017     Accepted: February 26, 2018     Published: April 13, 2018 ABSTRACT Whereas many studies have addressed the risk of organ dysfunction following hematopoietic stem cell transplantation (HSCT), little is known about pancreatic susceptibility in this setting. We aimed to investigate the effect of iron overload (IO) and total body irradiation (TBI) on pancreatic function of children undergoing HSCT. We retrospectively evaluated children admitted between 2012-2016 fulfilling the following criteria: normal pancreatic iron concentration (PIC), regular pancreatic function before HSCT, availability of abdominal magnetic resonance imaging with gradient-recalled-echo sequences and a full set of biochemical markers of IO and pancreatic function performed before HSCT and at discharge. We divided the patients according to the use of TBI or myeloablative chemotherapy (MCHT) in the conditioning regimen. All patients with severe IO or moderate IO with a high risk of engraftment delay or transplantation-related complications underwent chelation therapy with deferoxamine (DFO) from the first day of conditioning to discharge. 63 patients had a HSCT in the study period, 13 did not fulfill the inclusion criteria; 50 (25 in each group) are included in the analysis, and did not show differences at baseline evaluation. At follow up testing the TBI group showed a significantly higher PIC (107,8±100,3 μmol/g vs 28,4±37,9 in MCHT group, p 100 μmol/g at follow up had DFO-based chelation therapy, versus 26% of those with lower PIC (p<0,0001). The number of patients presenting exocrine pancreatic dysfunctions one month after transplantation was significantly higher in the TBI group (48% vs 4%; p<0.0001). The mean pancreatic volume reduction was significantly greater in the TBI group (39,1% vs 0,9% in the MCHT group; p<0,05), and was significantly worse on those who received DFO therapy. Based on our data, we suggest that TBI is detrimental for pancreatic functions, and speculate that DFO may contribute to the rapid pancreatic IO observed in these patients.