Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
Leuk Lymphoma. 2009 Oct;50(10):1566-72. doi: 10.1080/10428190903144659.
Many patients who undergo hematopoietic cell transplantation (HCT) present with anemia and have received red blood cell transfusions before HCT. As a result, iron overload is frequent and appears to be particularly prominent in patients with myelodysplastic syndromes. There is evidence that peritransplant events contribute to further iron accumulation, although the mechanism that disrupts normal iron homeostasis remains to be determined. Recent studies suggest that iron overload, as determined by ferritin levels, a surrogate marker for iron, is a risk factor for increased non-relapse mortality after HCT. Iron overload is associated with an increased rate of infections, in particular with fungal organisms. Furthermore anecdotal data suggest that increased hepatic iron may mimic the clinical picture of (chronic) graft-versus-host-disease (GVHD). Whether excess iron contributes to GVHD and whether iron depletion, be it by phlebotomy or chelation, reduces the post-transplantation complication rate and improves transplant outcome is yet to be determined.
许多接受造血细胞移植（HCT）的患者都伴有贫血，并在 HCT 前接受过红细胞输注。因此，铁过载很常见，在骨髓增生异常综合征患者中尤为明显。有证据表明，移植前事件会导致铁进一步积累，尽管破坏正常铁稳态的机制仍有待确定。最近的研究表明，铁过载（通过铁的替代标志物——血清铁蛋白水平来确定）是 HCT 后非复发死亡率增加的一个危险因素。铁过载与感染率增加有关，尤其是真菌感染。此外，传闻数据表明，肝内铁含量增加可能模拟（慢性）移植物抗宿主病（GVHD）的临床表现。过多的铁是否会导致 GVHD，以及是否通过放血或螯合作用来减少铁耗竭是否会降低移植后的并发症发生率并改善移植结果，仍有待确定。
