Kataoka Keisuke, Nannya Yasuhito, Hangaishi Akira, Imai Yoichi, Chiba Shigeru, Takahashi Tsuyoshi, Kurokawa Mineo
Department of Hematology & Oncology, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Biol Blood Marrow Transplant. 2009 Feb;15(2):195-204. doi: 10.1016/j.bbmt.2008.11.012.
Iron overload might be an important contributor to nonrelapse mortality (NRM) in hematopoietic stem cell transplantation (HSCT). We studied 264 patients undergoing allogeneic HSCT for hematologic malignancies between 1996 and 2006, using pretransplantation serum ferritin as a surrogate marker of iron overload. At 5 years, patients in the high ferritin group (>or= 599 ng/mL) had a lower overall survival (OS; 33.0% versus 63.5%; P< .001) and a higher NRM (34.9% versus 13.7%; P< .001) than those in the low ferritin group (<599 ng/mL). Multivariate analyses showed that high pretransplantation serum ferritin was a significant risk factor for worse survival (relative risk [RR]=1.68; P= .05) and increased NRM (RR=2.47; P= .01). There was no significant difference in the cumulative incidence of relapse, and acute and chronic graft-versus-host disease (aGVHD, cGVHD) between the 2 groups. Patients in the high ferritin group were more likely to die of infection (P< .010) and organ failure (P< .019). Similar results were observed after dividing the patients according to the intensity of conditioning regimens. These findings emphasize the prognostic impact of pretransplantation serum ferritin in HSCT recipients.
铁过载可能是造血干细胞移植（HSCT）中非复发死亡率（NRM）的一个重要促成因素。我们研究了1996年至2006年间接受异基因HSCT治疗血液系统恶性肿瘤的264例患者，使用移植前血清铁蛋白作为铁过载的替代标志物。5年时，高铁蛋白组（≥599 ng/mL）患者的总生存期（OS；33.0%对63.5%；P<0.001）低于低铁蛋白组（<599 ng/mL），NRM高于低铁蛋白组（34.9%对13.7%；P<0.001）。多变量分析显示，移植前血清铁蛋白水平高是生存较差（相对风险[RR]=1.68；P=0.05）和NRM增加（RR=2.47；P=0.01）的显著危险因素。两组之间的复发累积发生率以及急性和慢性移植物抗宿主病（aGVHD、cGVHD）无显著差异。高铁蛋白组患者更可能死于感染（P<0.010）和器官衰竭（P<0.019）。根据预处理方案的强度对患者进行分组后，观察到了类似的结果。这些发现强调了移植前血清铁蛋白对HSCT受者的预后影响。
