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Iron Overload in Children With Leukemia; Identification of a Cutoff Value for Serum Ferritin Level
Omid Reza Zekavat1, Farima Fallah Tafti, Mohammadreza Bordbar
1Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
Iron overload affects over a third of children with acute lymphoblastic leukemia (ALL) post-treatment. Serum ferritin and blood transfusion volume are effective, accessible markers for early detection in pediatric cancer patients.
Area of Science:
- Pediatric Oncology
- Hematology
- Medical Imaging
Background:
- Iron overload is a significant concern in leukemia patients.
- Early detection and monitoring are crucial for managing iron overload.
Purpose of the Study:
- To determine the prevalence of iron overload in children with acute lymphoblastic leukemia (ALL) after treatment cessation.
- To establish cutoff values for serum ferritin and blood transfusion volume as indicators of iron overload.
Main Methods:
- Prospective cohort study of 66 pediatric ALL patients.
- Serum ferritin levels measured 6 months post-treatment.
- T2* magnetic resonance imaging (MRI) of liver and heart performed.
- Receiver operating characteristic (ROC) curve analysis used to assess diagnostic value.
Main Results:
- 36.4% of patients exhibited iron overload in the heart or liver via T2* MRI.
- Serum ferritin demonstrated high accuracy (95.8% sensitivity, 85.7% specificity) with a cutoff of 238.5 ng/mL.
- Blood transfusion volume was a good predictor (75% sensitivity, 81% specificity) with a cutoff of 28.3 mL/kg.
Conclusions:
- Identified specific, validated cutoff values for serum ferritin and blood transfusion volume to predict iron overload.
- These markers provide a cost-effective and accessible method for periodic screening of iron deposition.
- Highlights the importance of monitoring iron overload in pediatric ALL survivors, especially in resource-limited settings.
Objective:
To determine the prevalence of iron overload in children with acute lymphoblastic leukemia (ALL) after treatment cessation and establish a cutoff value for serum ferritin level as an indicator of iron overload.
Background:
Early detection and monitoring of iron overload in patients with leukemia is crucial.
Methods:
In this prospective cohort study, 66 pediatric patients with ALL who were treated at a tertiary referral center affiliated with Shiraz University of Medical Sciences in Shiraz, Southern Iran, were investigated from July 2020 to December 2022. Serum ferritin levels were measured 6 months after treatment completion. T2* magnetic resonance imaging of the liver and heart was done for all patients. The receiver operating characteristic curve was used to illustrate the area under the receiver operating characteristic curve to assess the diagnostic value of serum ferritin level and total transfusion volume.
Results:
A total of 24 patients (36.4%) had iron overload in the heart or liver based on T2 magnetic resonance imaging findings. Serum ferritin level was a highly accurate diagnostic marker for iron overload in pediatric patients with ALL, with a sensitivity of 95.8%, and specificity of 85.7% for a cutoff value of 238.5 ng/mL. Also, blood transfusion was a good predictor of iron overload a sensitivity of 75% and specificity of 81% for a cutoff value of 28.3 mL/kg.
Conclusion:
We identified specific cutoff values for serum ferritin and blood transfusion volume to predict iron overload with high sensitivity and specificity. These markers offer a cost-effective and accessible approach for periodic screening of iron deposition, particularly in resource-constrained settings.
