Iron overload in hematopoietic cell transplantation

Area of Science:

• Hematology
• Transplantation Medicine
• Oncology

Background:

• Iron overload is a frequent complication in hematopoietic cell transplant (HCT) recipients, often linked to red blood cell (RBC) transfusions.
• This condition elevates the risk of post-transplant complications, including infections, veno-occlusive disease, and hepatic dysfunction.
• Elevated pretransplant ferritin levels may correlate with increased nonrelapse mortality and influence graft-versus-host disease (GVHD) risk.

Purpose of the Study:

• To review the challenges and current understanding of iron overload in HCT survivors.
• To highlight the limitations of serum ferritin as a sole diagnostic marker.
• To discuss diagnostic and therapeutic strategies for managing post-transplant iron overload.

Main Methods:

• Literature review focusing on iron overload in HCT recipients.
• Analysis of diagnostic methods for assessing body iron burden.
• Evaluation of treatment options, including phlebotomy and iron-chelation therapy.

Main Results:

• Serum ferritin is a sensitive but non-specific indicator of iron overload and a poor predictor of total body iron.
• Liver biopsy or MRI are recommended for accurate hepatic iron content estimation before therapy.
• Phlebotomy is the preferred treatment; iron chelation is reserved for non-phlebotomy candidates.
• Some survivors with mild overload and no organ damage may not require treatment.

Conclusions:

• Accurate assessment of iron burden is critical for managing iron overload in HCT survivors.
• Treatment strategies should be individualized based on iron levels and patient eligibility.
• Further research is needed to fully elucidate the long-term impact of iron overload on HCT survivor outcomes.