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Review
. 2018 Jul;97(27):e10310.
doi: 10.1097/MD.0000000000010310.

Effect of pre-transplantation serum ferritin on outcomes in patients undergoing allogeneic hematopoietic stem cell transplantation: A meta-analysis

Zhengwei Yan  1 , Xianying Chen, Huiping Wang, Yaling Chen, Lihong Chen, Peilin Wu, Wei Wang
Affiliations
Review

Effect of pre-transplantation serum ferritin on outcomes in patients undergoing allogeneic hematopoietic stem cell transplantation: A meta-analysis

Zhengwei Yan et al. Medicine (Baltimore). 2018 Jul.

Abstract

Background: Pre-transplantation serum ferritin (SF) has been considered to be a potential prognostic biomarker in patients undergoing allogeneic hematopoietic stem cell transplantation (allogeneic HSCT), but this conclusion remains controversial. Thus, we performed a meta-analysis to investigate the prognostic significance of pre-transplantation SF in patients undergoing allogeneic HSCT.

Methods: We systematically searched PubMed, Embase, and Web of Science up to September 2017, and finally identified a total of 25 eligible studies with 4545 patients.

Results: The pooled results of our meta-analysis showed that high pre-transplantation SF was markedly related to worse overall survival (OS) [hazard ratio (HR) = 1.82; 95% confidence interval (95% CI): 1.47-2.26; P < .001], nonrelapse mortality (NRM) (HR = 2.28; 95% CI: 1.79-2.89; P < .001), and progression-free survival (PFS) (HR = 1.72; 95% CI: 1.27-2.33; P < .001). In addition, high pre-transplantation SF was closely associated with a lower incidence of chronic graft versus host disease (cGVHD) (OR = 0.74, 95% CI: 0.58-0.96; P < .05), and a higher incidence of blood stream infections (BSIs) (OR = 1.67, 95% CI: 0.93-3.01; P = .09). However, no significance relationship was found between elevated pre-transplantation SF and acute graft versus host disease (aGVHD) (OR = 1.08, 95% CI:.72-1.62; P = .70).

Conclusion: In patients undergoing allogeneic HSCT for hematological malignancies, elevated pre-transplantation SF was significantly associated with worse OS and PFS, higher incidence of NRM and BSI, and lower incidence of cGVHD, but it had no effect on aGVHD. Considering the limitations in our meta-analysis, more prospective and homogeneous clinical studies are needed to further confirm our findings.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
The study flow of study selection process.
Figure 2
Figure 2
Meta-analysis of the prognostic significance of serum ferritin in overall survival.
Figure 3
Figure 3
Meta-analysis of the prognostic significance of SF in progression-free survival.
Figure 4
Figure 4
Meta-analysis of the prognostic significance of SF in nonrelapse mortality.
Figure 5
Figure 5
Meta-analysis of the association of SF with chronic graft versus host disease.
Figure 6
Figure 6
Meta-analysis of the association of SF with acute graft versus host disease.
Figure 7
Figure 7
Meta-analysis of the association of SF with blood stream infections.
Figure 8
Figure 8
The sensitivity analyses for the pooled HRs of overall survival (A), progression-free survival (B), and nonrelapse mortality (C). The funnel plot for publication bias about the correlation serum ferritin with nonrelapse mortality (D).
Figure 9
Figure 9
The funnel plots for publication bias about the correlation of SF with overall survival (A) and progression-free survival (B). The updated funnel plots for publication bias after trim-and-fill analysis about the correlation of SF with OS (C) and progression-free survival (D).
See this image and copyright information in PMC

References

    1. Horan JT, Logan BR, Agovi-Johnson MA, et al. Reducing the risk for transplantation-related mortality after allogeneic hematopoietic cell transplantation: how much progress has been made? J Clin Oncol 2011;29:805–13. - PMC - PubMed
    1. Jastaniah W, Harmatz P, Pakbaz Z, et al. Transfusional iron burden and liver toxicity after bone marrow transplantation for acute myelogenous leukemia and hemoglobinopathies. Pediatr Blood Cancer 2008;50:319–24. - PubMed
    1. Atilla E, Toprak SK, Demirer T. Current review of iron overload and related complications in hematopoietic stem cell transplantation. Turk J Haematol 2017;34:1–9. - PMC - PubMed
    1. Alessandrino EP, Della Porta MG, Bacigalupo A, et al. Prognostic impact of pre-transplantation transfusion history and secondary iron overload in patients with myelodysplastic syndrome undergoing allogeneic stem cell transplantation: a GITMO study. Haematologica 2010;95:476–84. - PMC - PubMed
    1. Kataoka K, Nannya Y, Hangaishi A, et al. Influence of pretransplantation serum ferritin on nonrelapse mortality after myeloablative and nonmyeloablative allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2009;15:195–204. - PubMed

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