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Leitch HA, Fibach E, Rachmilewitz E. Toxicity of iron overload and iron overload reduction in the setting of hematopoietic stem cell transplantation for hematologic malignancies. Crit Rev Oncol Hematol 2017; 113:156-170. [PMID: 28427505 DOI: 10.1016/j.critrevonc.2017.03.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/13/2017] [Accepted: 03/04/2017] [Indexed: 01/19/2023] Open
Abstract
Iron is an essential element for key cellular metabolic processes. However, transfusional iron overload (IOL) may result in significant cellular toxicity. IOL occurs in transfusion dependent hematologic malignancies (HM), may lead to pathological clinical outcomes, and IOL reduction may improve outcomes. In hematopoietic stem cell transplantation (SCT) for HM, IOL may have clinical importance; endpoints examined regarding an impact of IOL and IOL reduction include transplant-related mortality, organ function, infection, relapse risk, and survival. Here we review the clinical consequences of IOL and effects of IOL reduction before, during and following SCT for HM. IOL pathophysiology is discussed as well as available tests for IOL quantification including transfusion history, serum ferritin level, transferrin saturation, hepcidin, labile plasma iron and other parameters of iron-catalyzed oxygen free radicals, and organ IOL by imaging. Data-based recommendations for IOL measurement, monitoring and reduction before, during and following SCT for HM are made.
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Affiliation(s)
- Heather A Leitch
- Division of Hematology, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
| | - Eitan Fibach
- Hematology Branch, Hadassah - Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel
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52
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Jaspers A, Bouhya S, Belaiche S, Chevallier P, Hermet E, Hospital-Gustems C, Michallet M, Rialland F, Samsonova O, Sirvent A, Yakoub-Agha I, Rohrlich PS, Beguin Y. [Assessment and management of post-transplant iron overload: Guidelines of the Francophone Society of Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2016; 103:S255-S266. [PMID: 27842863 DOI: 10.1016/j.bulcan.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/01/2016] [Indexed: 01/19/2023]
Abstract
To harmonize clinical practice in hematopoietic stem cell transplantation, the Francophone Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the sixth annual series of workshops which brought together practitioners from all member centers and took place in September 2015 in Lille. The main aim of this session was to describe the impact, evaluation and treatment of post-transplant iron overload.
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Affiliation(s)
- Aurélie Jaspers
- CHU de Liège, service d'hématologie clinique, 4000 Liège, Belgique
| | - Salaheddine Bouhya
- CHRU de Montpellier, département d'hématologie clinique, 34295 Montpellier, France
| | | | | | - Eric Hermet
- CHU de Clermont-Ferrand, service d'hématologie clinique adulte, 63100 Clermont-Ferrand, France
| | | | | | - Fanny Rialland
- CHU de Nantes, service d'hématologie et oncologie pédiatriques, 44093 Nantes, France
| | - Olga Samsonova
- Centre hospitalier Lyon-Sud, service d'hématologie, 69310 Pierre-Bénite, France
| | - Anne Sirvent
- CHRU de Montpellier, département d'onco-hématologie pédiatrique, 34295 Montpellier, France
| | | | | | - Yves Beguin
- CHU de Liège, service d'hématologie clinique, 4000 Liège, Belgique.
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53
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Artz AS, Logan B, Zhu X, Akpek G, Bufarull RM, Gupta V, Lazarus HM, Litzow M, Loren A, Majhail NS, Maziarz RT, McCarthy P, Popat U, Saber W, Spellman S, Ringden O, Wickrema A, Pasquini MC, Cooke KR. The prognostic value of serum C-reactive protein, ferritin, and albumin prior to allogeneic transplantation for acute myeloid leukemia and myelodysplastic syndromes. Haematologica 2016; 101:1426-1433. [PMID: 27662010 DOI: 10.3324/haematol.2016.145847] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/26/2016] [Indexed: 01/02/2023] Open
Abstract
We sought to confirm the prognostic importance of simple clinically available biomarkers of C-reactive protein, serum albumin, and ferritin prior to allogeneic hematopoietic cell transplantation. The study population consisted of 784 adults with acute myeloid leukemia in remission or myelodysplastic syndromes undergoing unrelated donor transplant reported to the Center for International Blood and Marrow Transplant Research. C-reactive protein and ferritin were centrally quantified by ELISA from cryopreserved plasma whereas each center provided pre-transplant albumin. In multivariate analysis, transplant-related mortality was associated with the pre-specified thresholds of C-reactive protein more than 10 mg/L (P=0.008) and albumin less than 3.5 g/dL (P=0.01) but not ferritin more than 2500 ng/mL. Only low albumin independently influenced overall mortality. Optimal thresholds affecting transplant-related mortality were defined as: C-reactive protein more than 3.67 mg/L, log(ferritin), and albumin less than 3.4 g/dL. A 3-level biomarker risk group based on these values separated risks of transplant-related mortality: low risk (reference), intermediate (HR=1.66, P=0.015), and high risk (HR=2.7, P<0.001). One-year survival was 74%, 67% and 56% for low-, intermediate- and high-risk groups. Routinely available pre-transplant biomarkers independently risk-stratify for transplant-related mortality and survival.
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Affiliation(s)
- Andrew S Artz
- Section of Hematology/Oncology, University of Chicago School of Medicine, IL, USA
| | - Brent Logan
- CIBMTR, (Center for International Blood and Marrow Transplant Research), Department of Medicine, Milwaukee, WI, USA.,Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Xiaochun Zhu
- CIBMTR, (Center for International Blood and Marrow Transplant Research), Department of Medicine, Milwaukee, WI, USA
| | - Gorgun Akpek
- Stem Cell Transplantation and Cellular Therapy Program, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | | | - Vikas Gupta
- Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Mark Litzow
- Division of Hematology and Transplant Center, Mayo Clinic Rochester, Minneapolis, MN, USA
| | - Alison Loren
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, OH, USA
| | - Richard T Maziarz
- Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Philip McCarthy
- Blood & Marrow Transplant Program, Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Uday Popat
- MD Anderson Cancer Center, Houston, TX, USA
| | - Wael Saber
- CIBMTR, (Center for International Blood and Marrow Transplant Research), Department of Medicine, Milwaukee, WI, USA
| | - Stephen Spellman
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
| | - Olle Ringden
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.,Centre for Allogeneic Stem Cell Transplantation, Stockholm, Sweden
| | - Amittha Wickrema
- Section of Hematology/Oncology, University of Chicago School of Medicine, IL, USA
| | - Marcelo C Pasquini
- CIBMTR, (Center for International Blood and Marrow Transplant Research), Department of Medicine, Milwaukee, WI, USA
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Nogai A, Shi Y, Pérez-Hernandez D, Cordes S, Mengwasser J, Mertlitz S, Riesner K, Kalupa M, Erdmann JH, Ziebig R, Dittmar G, Penack O. Organ siderosis and hemophagocytosis during acute graft-versus-host disease. Haematologica 2016; 101:e344-6. [PMID: 27198715 DOI: 10.3324/haematol.2016.144519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Axel Nogai
- Department of Hematology, Oncology and Transfusion Medicine, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Yu Shi
- Department of Hematology, Oncology and Tumorimmunology, Charité Campus Virchow, Berlin, Germany
| | | | - Steffen Cordes
- Department of Hematology, Oncology and Tumorimmunology, Charité Campus Virchow, Berlin, Germany
| | - Jörg Mengwasser
- Department of Hematology, Oncology and Tumorimmunology, Charité Campus Virchow, Berlin, Germany
| | - Sarah Mertlitz
- Department of Hematology, Oncology and Tumorimmunology, Charité Campus Virchow, Berlin, Germany
| | - Katarina Riesner
- Department of Hematology, Oncology and Tumorimmunology, Charité Campus Virchow, Berlin, Germany
| | - Martina Kalupa
- Department of Hematology, Oncology and Tumorimmunology, Charité Campus Virchow, Berlin, Germany
| | - Jan-Hendrik Erdmann
- Department of Hematology, Oncology and Tumorimmunology, Charité Campus Virchow, Berlin, Germany
| | - Reinhard Ziebig
- Department for Laboratory Medicine and Pathobiochemistry, Charité Campus Mitte, Berlin, Germany
| | - Gunnar Dittmar
- Max-Delbrück-Centrum for Molecular Medicine, Berlin, Germany
| | - Olaf Penack
- Department of Hematology, Oncology and Tumorimmunology, Charité Campus Virchow, Berlin, Germany
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55
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Hematopoietic Stem Cell Transplantation. PATHOLOGY OF TRANSPLANTATION 2016. [PMCID: PMC7124099 DOI: 10.1007/978-3-319-29683-8_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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56
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Efficacy and safety of deferasirox in non-thalassemic patients with elevated ferritin levels after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2015; 51:89-95. [DOI: 10.1038/bmt.2015.204] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/18/2015] [Accepted: 07/23/2015] [Indexed: 12/22/2022]
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57
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Indication and management of allogeneic stem cell transplantation in primary myelofibrosis: a consensus process by an EBMT/ELN international working group. Leukemia 2015; 29:2126-33. [PMID: 26293647 DOI: 10.1038/leu.2015.233] [Citation(s) in RCA: 205] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/10/2015] [Indexed: 12/15/2022]
Abstract
The aim of this work is to produce recommendations on the management of allogeneic stem cell transplantation (allo-SCT) in primary myelofibrosis (PMF). A comprehensive systematic review of articles released from 1999 to 2015 (January) was used as a source of scientific evidence. Recommendations were produced using a Delphi process involving a panel of 23 experts appointed by the European LeukemiaNet and European Blood and Marrow Transplantation Group. Key questions included patient selection, donor selection, pre-transplant management, conditioning regimen, post-transplant management, prevention and management of relapse after transplant. Patients with intermediate-2- or high-risk disease and age <70 years should be considered as candidates for allo-SCT. Patients with intermediate-1-risk disease and age <65 years should be considered as candidates if they present with either refractory, transfusion-dependent anemia, or a percentage of blasts in peripheral blood (PB) >2%, or adverse cytogenetics. Pre-transplant splenectomy should be decided on a case by case basis. Patients with intermediate-2- or high-risk disease lacking an human leukocyte antigen (HLA)-matched sibling or unrelated donor, should be enrolled in a protocol using HLA non-identical donors. PB was considered the most appropriate source of hematopoietic stem cells for HLA-matched sibling and unrelated donor transplants. The optimal intensity of the conditioning regimen still needs to be defined. Strategies such as discontinuation of immune-suppressive drugs, donor lymphocyte infusion or both were deemed appropriate to avoid clinical relapse. In conclusion, we provided consensus-based recommendations aimed to optimize allo-SCT in PMF. Unmet clinical needs were highlighted.
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58
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59
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Muffly L. Patient selection for allogeneic hematopoietic cell transplantation (HCT): the evolution of HCT risk assessment. Curr Hematol Malig Rep 2014; 10:28-34. [PMID: 25500987 DOI: 10.1007/s11899-014-0241-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of allogeneic hematopoietic cell transplantation is expanding, with disproportionate growth witnessed in older adults with hematologic malignancies. As the chronological age barrier to transplant fades, refining the pre-hematopoietic cell transplantation (HCT) risk assessment to better capture host health status and disease characteristics is essential. This review summarizes recent efforts to move the field forward towards achieving this goal. Many of these risk assessment tools are currently included in prospective clinical trials; routine clinical use requires greater understanding of how to best incorporate this new information into HCT decision making.
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Affiliation(s)
- Lori Muffly
- Division of Blood and Marrow Transplantation, Stanford University, 300 Pasteur Drive, H0144B, Stanford, CA, 94305-5623, USA,
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60
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Kew AK, Clarke S, Ridler A, Burrell S, Edwards JA, Doucette S, Couban S. A prospective cohort study of the feasibility and efficacy of iron reduction by phlebotomy in recipients of hematopoietic SCT. Bone Marrow Transplant 2014; 50:457-8. [DOI: 10.1038/bmt.2014.273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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