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. 2020 Sep;26(9):1697-1703.
doi: 10.1016/j.bbmt.2020.06.002. Epub 2020 Jun 11.

Iron Overload Is Associated with Delayed Engraftment and Increased Nonrelapse Mortality in Recipients of Umbilical Cord Blood Hematopoietic Cell Transplantation

Monzr M Al Malki  1 , Joo Y Song  2 , Dongyun Yang  3 , Thai Cao  4 , Ibrahim Aldoss  4 , Sally Mokhtari  5 , Sanjeet Dadwal  6 , Guido Marcucci  4 , Chatchada Karanes  4 , David Snyder  4 , Auayporn Nademanee  4 , Stephen J Forman  4 , Ryotaro Nakamura  4 , Vinod Pullarkat  4
Affiliations

Iron Overload Is Associated with Delayed Engraftment and Increased Nonrelapse Mortality in Recipients of Umbilical Cord Blood Hematopoietic Cell Transplantation

Monzr M Al Malki et al. Biol Blood Marrow Transplant. 2020 Sep.

Abstract

The negative impact of iron overload (IO) on outcomes of allogeneic hematopoietic cell transplantation (HCT) is well recognized, but its impact on umbilical cord blood (UCB) transplant outcome is unknown. We retrospectively analyzed outcomes of 150 patients who received UCB-HCT at our institution, stratified by pre-HCT serum ferritin (SF) level of 2000 ng/mL. Two-year overall survival rate among patients with SF >2000 and ≤2000 ng/mL was 26.1% (95% CI, 10.6% to 44.7%) and 52.1% (95% CI, 40.1% to 62.8%), respectively; hazard ratio (HR) = 2.26 (95% CI, 1.28 to 4.00, P = .005). Two-year nonrelapse mortality rate was higher among patients with SF >2000 ng/mL (56.5%; 95% CI, 33.3% to 74.4%) compared to SF ≤2000 ng/mL (30.1%; 95% CI, 20.0% to 40.9%); HR = 2.18 (95% CI, 1.10 to 4.31, P = .025). Neutrophil engraftment at 42 days was 78.3% (95% CI, 53.5% to 90.8%) in patients with SF >2000 ng/mL versus 91.8% (95% CI, 82.1% to 96.4%) in patients with SF ≤2000 ng/mL; HR = 0.58 (95% CI, 0.35 to 0.96, P = .034). A significant difference in platelet engraftment at 3 months was also observed: 52.2% (95% CI, 29.4% to 70.8%) for SF >2000 ng/mL versus 80.8% (95% CI, 69.5% to 88.3%) for SF ≤2000 ng/mL; HR = 0.48 (95% CI, 0.23 to 0.98, P = .044). In conclusion, IO defined by SF of 2000 ng/mL is a strong adverse prognostic factor for UCB-HCT and should be considered when UCB is chosen as the graft source for patients without a fully matched donor.

Keywords: Engraftment; Hematopoietic cell transplantation; Iron overload; Nonrelapse mortality; Serum ferritin; Umbilical cord blood.

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Conflict of interest statement

COMPETING INTERESTS

VP has served on Advisory Boards and Speakers Bureau for Novartis. The remaining authors have no relevant conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Kaplan-Meier curves comparing survival outcomes in recipients of UCB-HCT with serum ferritin levels of ≤2000 ng/ml and >2000 ng/ml. (a) Overall survival, and (b) Non-relapse mortality
Figure 2.
Figure 2.
Kaplan-Meier curves comparing engraftment outcomes in recipients of UCB-HTB with serum ferritin levels of ≤2000 ng/ml and >2000 ng/ml. (a) cumulative incidence of neutrophil engraftment, and (b) cumulative incidence of platelet engraftment
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