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
Author
Penack, Olaf; Peczynski, Christophe; van der Werf, Steffie; Finke, Jürgen; Ganser, Arnold; Schoemans, Helene; Pavlu, Jiri; Niittyvuopio, Riitta; Schroyens, Wilfried; Kaynar, Leylagül; Blau, Igor W.; van der Velden, Walter J.F.M.; Sierra, Jorge; Cortelezzi, Agostino; Wulf, Gerald; Turlure, Pascal; Rovira, Montserrat; Ozkurt, Zubeydenur; Pascual-Cascon, Maria J.; Moreira, Maria C.; Clausen, Johannes; Greinix, Hildegard; Duarte Palomino, Rafael; Basak, Grzegorz W.Entity
UAM. Departamento de MedicinaPublisher
Frontiers MediaDate
2020-04-15Citation
10.3389/fimmu.2020.00586
Frontiers in Immunology 11.April (2020): 586
ISSN
1664-3224DOI
10.3389/fimmu.2020.00586Funded by
JP acknowledges the support of the Imperial NIHR-BCR. OP acknowledges the support of José Carreras Leukämie-Stiftung (11R2016 and 3R2019), Deutsche Krebshilfe (70113519), and Deutsche Forschungsgemeinschaft (PE 1450/7-1)Editor's Version
http://doi.org/10.3389/fimmu.2020.00586Subjects
biomarker; ferritin; immunology; iron metabolism; stem cell; transplantation; MedicinaRights
© 2020 Penack, Peczynski, van der Werf, Finke, Ganser, Schoemans, Pavlu, Niittyvuopio, Schroyens, Kaynar, Blau, van der Velden, Sierra, Cortelezzi, Wulf, Turlure, Rovira, Ozkurt, Pascual-Cascon, Moreira, Clausen, Greinix, Duarte and Basak.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.
Files in this item
Google Scholar:Penack, Olaf
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Peczynski, Christophe
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van der Werf, Steffie
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Finke, Jürgen
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Ganser, Arnold
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Schoemans, Helene
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Pavlu, Jiri
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Niittyvuopio, Riitta
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Schroyens, Wilfried
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Kaynar, Leylagül
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Blau, Igor W.
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van der Velden, Walter J.F.M.
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Sierra, Jorge
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Cortelezzi, Agostino
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Wulf, Gerald
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Turlure, Pascal
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Rovira, Montserrat
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Ozkurt, Zubeydenur
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Pascual-Cascon, Maria J.
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Moreira, Maria C.
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Clausen, Johannes
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Greinix, Hildegard
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Duarte Palomino, Rafael
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Basak, Grzegorz W.
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