LIFE Cancer Survivorship & Transition Program, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Pediatr Blood Cancer. 2012 Oct;59(4):697-702. doi: 10.1002/pbc.24046. Epub 2011 Dec 20.
Packed red blood cell (PRBC) transfusion is a mainstay in childhood cancer treatment, but has potential for inducing iron overload. The purpose of this study was to determine whether treatment intensity is predictive of projected iron burden resulting from PRBC transfusions among survivors of several forms of childhood cancer.
This retrospective cohort study involved patients treated at Children's Hospital Los Angeles (CHLA) between June 1, 2004 and December 31, 2009. Clinical/demographic data were abstracted from medical records. Treatment Intensity Level was determined for each patient using a published scale. Adjusted cumulative PRBC transfusion volume for each patient (ml/kg) was used to compute the adjusted total iron burden (mg/kg) based upon the average hematocrit of the product.
Median age of the cohort (n = 214) was 7.9 years (range 0.2-20.2). One hundred and fourteen (53.3%) were male and 129 (60.3%) were Hispanic/Latino. Diagnoses included acute leukemia and six solid tumors, management of which represents a range of cancer treatment intensities. The number of transfusions, transfusion volumes, and projected iron burden were significantly increased and exceeded upper limits of normal among patients with higher treatment intensity. Multivariate analysis found younger age and lower hemoglobin at diagnosis to be associated with greater iron burden after adjusting for treatment intensity.
Greater treatment intensity is associated with need for more PRBC transfusions, and thus increased risk of iron overload among childhood cancer survivors. Iron overload may represent another clinically significant late effect following childhood cancer treatment.
浓缩红细胞（PRBC）输血是儿童癌症治疗的主要手段，但有引起铁过载的潜在风险。本研究的目的是确定治疗强度是否可预测几种儿童癌症幸存者因 PRBC 输血而导致的预计铁负荷。
这是一项回顾性队列研究，涉及 2004 年 6 月 1 日至 2009 年 12 月 31 日期间在洛杉矶儿童医院（CHLA）接受治疗的患者。从病历中提取临床/人口统计学数据。使用已发表的量表确定每位患者的治疗强度级别。根据产品的平均红细胞压积，为每位患者计算调整后的累积 PRBC 输血量（ml/kg），以计算调整后的总铁负荷（mg/kg）。
队列（n = 214）的中位年龄为 7.9 岁（范围 0.2-20.2）。114 名（53.3%）为男性，129 名（60.3%）为西班牙裔/拉丁裔。诊断包括急性白血病和六种实体瘤，这些疾病的治疗代表了不同的癌症治疗强度。在治疗强度较高的患者中，输血次数、输血量和预计铁负荷显著增加，并超过正常值上限。多变量分析发现，年龄较小和诊断时血红蛋白水平较低与调整治疗强度后铁负荷增加有关。
治疗强度越大，需要的 PRBC 输血越多，因此儿童癌症幸存者发生铁过载的风险增加。铁过载可能是儿童癌症治疗后另一种具有临床意义的迟发性效应。
