Gu C H, Li C X, Ye L, Liu H, Ma J F, Wang T, Zou Q, Chen J, Chen X C, Wu D P
Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou 215006, China.
Zhonghua Xue Ye Xue Za Zhi. 2016 Mar;37(3):189-93. doi: 10.3760/cma.j.issn.0253-2727.2016.03.003.
To investigate the effects of iron chelation therapy on hematopoietic reconstitution and related complications of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with myelodysplastic syndrome (MDS).
Various clinical parameters were analyzed retrospectively in 57 MDS patients with iron overload who received allo-HSCT. According to the level of serum ferritin (SF) before transplantation divided patients into two groups: the effective treatment group (SF<1 000 μg/L) and iron overload group (SF≥1 000 μg/L).
①30/57 cases were received iron chelation treatment, 27/57 patients didn' t received iron chelating therapy before transplantation. 19/30 cases were in the effective treatment group, and the median SF level before transplantation was 561 (223-846) μg/L. 11/30 cases were in the iron overload group, and the median SF level before transplantation was 1 262 (1 100-2 352) μg/L. The median SF level was 1 540 (1 320-3 112) μg/L of 27 patients didn't received iron chelating therapy before transplantation. ② The rate of fully-engraftment in the effective treatment group and iron overload group was 19 cases (100.0% ) and 34 cases (89.5% ), myeloid reconstitution of 12(10-18) and 12(11-30) days respectively (P=0.441), and platelet reconstitution of 13(12-30) and 15 (10-32) days respectively (P=0.579). ③The infection risk rate of the effective treatment group was less than iron overload group [36.8% (7/19) vs 82.4% (28/34), P=0.002]. ④The incidence of aGVHD in effective treatment group was less than iron overload group [26.3%(5/19) vs 64.7%(22/34), P= 0.010]. All patients of the effective treatment group were Ⅰ/Ⅱ degree. 16 cases were Ⅰ/Ⅱ degree and 6 cases were Ⅲ/Ⅳ degree in the iron overload group. ⑤ 6 cases of iron overload group accepted iron chelation treatment early post-transplantation, and SF level decreased from 2 870 (2 205-3 580) μg/L to 1 270 (1 020-1 650) μg/L. ⑥The difference of median disease-free survival time between the effective treatment group and iron overload group was not statistically significant [28.9 (0.3-89.5) months vs 21.2(0.1-81.0) months, χ(2)=3.751, P=0.053].
Iron overload obviously increased transplant-related complications, and effective iron chelation therapy before transplantation significantly decreased the incidence of infection and degree of aGVHD, thereby reduced the non-relapse mortality in patients with MDS.
探讨铁螯合疗法对骨髓增生异常综合征（MDS）患者异基因造血干细胞移植（allo-HSCT）造血重建及相关并发症的影响。
回顾性分析57例接受allo-HSCT且存在铁过载的MDS患者的各项临床参数。根据移植前血清铁蛋白（SF）水平将患者分为两组：有效治疗组（SF<1 000 μg/L）和铁过载组（SF≥1 000 μg/L）。
①57例患者中30例接受了铁螯合治疗，27例在移植前未接受铁螯合治疗。30例接受铁螯合治疗的患者中，19例属于有效治疗组，移植前SF水平中位数为561（223 - 846）μg/L。11例属于铁过载组，移植前SF水平中位数为1 262（1 100 - 2 352）μg/L。27例移植前未接受铁螯合治疗的患者SF水平中位数为1 540（1 320 - 3 112）μg/L。②有效治疗组和铁过载组的完全植入率分别为19例（100.0%）和34例（89.5%），髓系造血重建时间分别为12（10 - 18）天和12（11 - 30）天（P = 0.441），血小板造血重建时间分别为13（12 - 30）天和15（10 - 32）天（P = 0.579）。③有效治疗组的感染风险率低于铁过载组[36.8%（7/19）对82.4%（28/34），P = 0.002]。④有效治疗组急性移植物抗宿主病（aGVHD）的发生率低于铁过载组[26.3%（5/19）对64.7%（22/34），P = 0.010]。有效治疗组所有患者均为Ⅰ/Ⅱ度。铁过载组16例为Ⅰ/Ⅱ度，6例为Ⅲ/Ⅳ度。⑤铁过载组6例患者在移植后早期接受了铁螯合治疗，SF水平从2 870（2 205 - 3 580）μg/L降至1 270（1 020 - 1 650）μg/L。⑥有效治疗组和铁过载组的无病生存时间中位数差异无统计学意义[28.9（0.3 - 89.5）个月对21.2（0.1 - 81.0）个月，χ² = 3.751，P = 0.053]。
铁过载明显增加移植相关并发症，移植前有效的铁螯合疗法显著降低感染发生率和aGVHD程度，从而降低MDS患者的非复发死亡率。
