铁过载与异基因造血细胞移植结局的关系:一项使用 R2-MRI 测量肝铁含量的前瞻性队列研究。
Association of iron overload with allogeneic hematopoietic cell transplantation outcomes: a prospective cohort study using R2-MRI-measured liver iron content.
机构信息
Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA.
出版信息
Blood. 2013 Aug 29;122(9):1678-84. doi: 10.1182/blood-2013-04-499772. Epub 2013 Jun 18.
Using liver magnetic resonance imaging (R2-MRI) to quantify liver iron content (LIC), we conducted a prospective cohort study to determine the association between iron overload and adult allogeneic hematopoietic cell transplantation (HCT) outcomes. Patients received pretransplant ferritin measurements; patients with ferritin >500 ng/mL underwent R2-MRI. Patients were defined as no iron overload (N = 28) and iron overload (LIC >1.8 mg/g; N = 60). Median LIC in the iron-overload group was 4.3 mg/g (range, 1.9-25.4). There was no difference in the 1-year probability of overall survival, nonrelapse mortality, relapse, acute or chronic graft-versus-host disease, organ failure, infections, or hepatic veno-occlusive disease between groups. We also found no difference in the cumulative incidence of a composite end point of nonrelapse mortality, any infection, organ failure, or hepatic veno-occlusive disease (1-year cumulative incidence, 71% vs 80%; P = .44). In multivariate analyses, iron-overload status did not impact risks of overall mortality (relative risk = 2.3; 95% confidence interval, 0.9-5.9; P = .08). In conclusion, we found no association between pretransplant iron overload and allogeneic HCT outcomes. Future studies in this population should use LIC to define iron overload instead of ferritin.
我们采用肝脏磁共振成像(R2-MRI)来定量肝脏铁含量(LIC),进行了一项前瞻性队列研究,以确定铁过载与成人异基因造血细胞移植(HCT)结局之间的关联。患者接受移植前铁蛋白检测;铁蛋白>500ng/ml 的患者行 R2-MRI。将患者定义为无铁过载(N=28)和铁过载(LIC>1.8mg/g;N=60)。铁过载组的中位 LIC 为 4.3mg/g(范围,1.9-25.4)。两组间 1 年总生存率、非复发死亡率、复发、急性或慢性移植物抗宿主病、器官衰竭、感染或肝静脉闭塞病无差异。我们还发现两组间非复发死亡率、任何感染、器官衰竭或肝静脉闭塞病复合终点的累积发生率无差异(1 年累积发生率,71% vs 80%;P=0.44)。多变量分析显示,铁过载状态并不影响总死亡率的风险(相对风险=2.3;95%置信区间,0.9-5.9;P=0.08)。总之,我们未发现移植前铁过载与异基因 HCT 结局之间存在关联。该人群的未来研究应使用 LIC 来定义铁过载,而不是铁蛋白。