A prospective non-interventional study on the impact of transfusion burden and related iron toxicity on outcome in myelodysplastic syndromes undergoing allogeneic hematopoietic cell transplantation*

Eline M.P. Cremers*, Theo de Witte, Liesbeth de Wreede, Diderik Jan Eikema, Linda Koster, Anja van Biezen, Jürgen Finke, Gerard Socié, Dietrich Beelen, Johan Maertens, Arnon Nagler, Guido Kobbe, Dimitris Ziagkos, Maija Itälä-Remes, Tobias Gedde-Dahl, Jorge Sierra, Dietger Niederwieser, Per Ljungman, Yves Beguin, Zubeyde Nur OzkurtAchilles Anagnostopoulos, Pavel Jindra, Marie Robin, Nicolaus Kröger

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Most myelodysplastic syndromes (MDS)-patients receive multiple red blood cell transfusions (RBCT). Transfusions may cause iron-related toxicity and mortality, influencing outcome after allogeneic HSCT. This prospective non-interventional study evaluated 222 MDS and CMML patients undergoing HSCT. Overall survival (OS), relapse-free survival (RFS), non-relapse mortality (NRM), and relapse incidence (RI) at 36 months were 52%, 44%, 25%, and 31%, respectively. Age, percentage of marrow blasts and severe comorbidities impacted OS. RFS was significantly associated with RBCT burden prior to HSCT (HR: 1.7; p =.02). High ferritin levels had a significant negative impact on OS and RI, but no impact on NRM. Administration of iron chelation therapy prior to HSCT did not influence the outcome, but early iron reduction after HSCT (started before 6 months) improved RFS significantly after transplantation (56% in the control group vs. 90% in the treated group, respectively; p =.04). This study illustrates the impact of RBCT and related parameters on HSCT-outcome. Patients with an expected prolonged survival after transplantation may benefit from early iron reduction therapy after transplantation.

Original languageEnglish
Pages (from-to)2404-2414
Number of pages11
JournalLeukemia and Lymphoma
Volume60
Issue number10
DOIs
StatePublished - 24 Aug 2019
Externally publishedYes

Funding

FundersFunder number
Novartis

    Keywords

    • MDS
    • allogeneic stem cell transplantation
    • chelation therapy
    • phlebotomies
    • transfusions

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