Sivgin Serdar, Baldane Suleyman, Akyol Gulsah, Keklik Muzaffer, Kaynar Leylagül, Kurnaz Fatih, Pala Cigdem, Zararsiz Gokmen, Cetin Mustafa, Eser Bulent, Unal Ali
Dedeman Stem Cell Transplantation Hospital, Department of Hematology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
Transfus Apher Sci. 2013 Oct;49(2):295-301. doi: 10.1016/j.transci.2013.07.004. Epub 2013 Aug 2.
Iron overload (IO) has been shown to be an important cause of mortality and morbidity in patients who underwent allogeneic hematopoietic stem cell transplantation (alloHSCT). This study aimed to evaluate the possible effect of oral iron-chelation treatment (deferasirox) on survival in alloHSCT recipients in the posttransplant period.
A total of 80 alloHSCT recipients with IO were analyzed, retrospectively. Pretransplant and posttransplant data were obtained from the patients' files. Patients were divided into two groups. Group 1; patients who did not receive any chelator treatment due to side effects or compliance problems. These patients were treated by phlebotomy. Group 2 consisted of patients who received deferasirox treatment.
The median treatment duration with deferasirox was 122 days (min-max:91-225). The iron chelating treatment significantly reduced serum ferritin levels administered at a dosage of 20-30 mg/kg/day (p<0.001). The median OS in Group 1 was found 16.0 (min-max:1.0-63.0) months and 25.0 (min-max:3.0-72.0) months in Group 2. In univariate and multivariate analysis, patients in Group 1 showed poorer OS compared to those in Group 2 with an increase in risk of death (HR:3.22, min-max:1.67-6.23, p=0.001 and HR:3.51,, min-max:1.75-6.99, p<0.001; respectively). The median DFS in Group 1 was found 11.0 (min-max:3.0-24.0) months and 22.0 (min-max:8.0-43.0) months in Group 2. The difference was found statistically significant (p=0.023). The other factors that we found significant difference in multivariate analysis between groups were; presence of acute GVHD (patients with aGVHD had increased risk of death compared to patients without aGVHD (HR:2.49, min-max: 1.32-4.69, p=0.005), chronic GVHD (HR:2.57, min-max:1.23-5.41, p=0.013), median interval to tx (HR: 2.23, min-max:1.17-4.26, p=0.015) and HLA match (HR:3.01, min-max:1.35-6.73, p=0.007) CONCLUSION: Oral deferasirox (Exjade) treatment may improve survival in patients with iron overload who underwent alloHSCT.
铁过载（IO）已被证明是接受异基因造血干细胞移植（alloHSCT）患者死亡和发病的重要原因。本研究旨在评估口服铁螯合治疗（地拉罗司）对alloHSCT受者移植后生存期的可能影响。
回顾性分析80例患有铁过载的alloHSCT受者。从患者病历中获取移植前和移植后的数据。患者分为两组。第1组：因副作用或依从性问题未接受任何螯合剂治疗的患者。这些患者采用放血疗法治疗。第2组由接受地拉罗司治疗的患者组成。
地拉罗司的中位治疗持续时间为122天（最小值 - 最大值：91 - 225天）。以20 - 30mg/kg/天的剂量进行铁螯合治疗可显著降低血清铁蛋白水平（p<0.001）。第1组的中位总生存期为16.0（最小值 - 最大值：1.0 - 63.0）个月，第2组为25.0（最小值 - 最大值：3.0 - 72.0）个月。在单因素和多因素分析中，第1组患者的总生存期较第2组差，死亡风险增加（风险比：3.22，最小值 - 最大值：1.67 - 6.23，p = 0.001；风险比：3.51，最小值 - 最大值：1.75 - 6.99，p<0.001）。第1组的中位无病生存期为11.0（最小值 - 最大值：3.0 - 24.0）个月，第2组为22.0（最小值 - 最大值：8.0 - 43.0）个月。差异具有统计学意义（p = 0.023）。我们在多因素分析中发现两组之间存在显著差异的其他因素包括：急性移植物抗宿主病（与无急性移植物抗宿主病的患者相比，急性移植物抗宿主病患者的死亡风险增加（风险比：2.49，最小值 - 最大值：1.32 - 4.69，p = 0.005））、慢性移植物抗宿主病（风险比：2.57，最小值 - 最大值：1.23 - 5.41，p = 0.013）、至治疗的中位间隔时间（风险比：2.23，最小值 - 最大值：1.17 - 4.26，p = 0.015）和人类白细胞抗原匹配（风险比：3.01，最小值 - 最大值：1.35 - 6.73，p = 0.007）。结论：口服地拉罗司（恩瑞格）治疗可能改善接受alloHSCT的铁过载患者的生存期。
