Association of Serum Ferritin Levels Before Start of Conditioning With Mortality After alloSCT – A Prospective, Non-interventional Study of the EBMT Transplant Complications Working Party

Olaf Penack, Christophe Peczynski, Steffie van der Werf, Jürgen Finke, Arnold Ganser, Helene Schoemans, Jiri Pavlu, Riitta Niittyvuopio, Wilfried Schroyens, Leylagül Kaynar, Igor W. Blau, Walter J.F.M. van der Velden, Jorge Sierra, Agostino Cortelezzi, Gerald Wulf, Pascal Turlure, Montserrat Rovira, Zubeydenur Ozkurt, Maria J. Pascual-Cascon, Maria C. MoreiraJohannes Clausen, Hildegard Greinix, Rafael F. Duarte, Grzegorz W. Basak

Research output: Contribution to journalArticlepeer-review

Abstract

Elevated serum ferritin levels occur due to iron overload or during inflammation and macrophage activation. A correlation of high serum ferritin levels with increased mortality after alloSCT has been suggested by several retrospective analyses as well as by two smaller prospective studies. This prospective multicentric study aimed to study the association of ferritin serum levels before start of conditioning with alloSCT outcome. Patients with acute leukemia, lymphoma or MDS receiving a matched sibling alloSCT for the first time were considered for inclusion, regardless of conditioning. A comparison of outcomes between patients with high and low ferritin level was performed using univariate analysis and multivariate analysis using cause-specific Cox model. Twenty centers reported data on 298 alloSCT recipients. The ferritin cut off point was determined at 1500 μg/l (median of measured ferritin levels). In alloSCT recipients with ferritin levels above cut off measured before the start of conditioning, overall survival (HR = 2.5, CI = 1.5–4.1, p = 0.0005) and progression-free survival (HR = 2.4, CI = 1.6–3.8, p < 0.0001) were inferior. Excess mortality in the high ferritin group was due to both higher relapse incidence (HR = 2.2, CI = 1.2–3.8, p = 0.007) and increased non-relapse mortality (NRM) (HR = 3.1, CI = 1.5–6.4, p = 0.002). NRM was driven by significantly higher infection-related mortality in the high ferritin group (HR = 3.9, CI = 1.6–9.7, p = 0.003). Acute and chronic GVHD incidence or severity were not associated to serum ferritin levels. We conclude that ferritin levels can serve as routine laboratory biomarker for mortality risk assessment before alloSCT.

Original languageEnglish
Article number586
JournalFrontiers in Immunology
Volume11
DOIs
Publication statusPublished - Apr 15 2020

Keywords

  • biomarker
  • ferritin
  • immunology
  • iron metabolism
  • stem cell
  • transplantation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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