Sirvent A, Auquier P, Oudin C, Bertrand Y, Bohrer S, Chastagner P, Poirée M, Kanold J, Thouvenin S, Perel Y, Plantaz D, Tabone M-D, Yakouben K, Gandemer V, Lutz P, Sirvent N, Vercasson C, Berbis J, Chambost H, Leverger G, Baruchel A, Michel G
Department of Pediatric Hematology and Oncology, University Hospital, Montpellier, France.
Research Unit EA 3279 and Department of Public Health, Aix-Marseille University and Timone Hospital, Marseille, France.
Bone Marrow Transplant. 2017 Jan;52(1):80-87. doi: 10.1038/bmt.2016.205. Epub 2016 Sep 5.
Data on post-transplant iron overload (IO) are scarce in pediatrics. We conducted a prospective multicenter cohort study (Leucémie de l'Enfant et de l'Adolescent cohort) to determine the prevalence and risk factors of IO in 384 acute leukemia survivors transplanted during childhood. Prevalence of IO (ferritin level ⩾350 ng/mL) was 42.2% (95%CI 37.2-47.2%). Factors significantly associated with IO were: 1) in univariate analysis: older age at transplant (P<0.001), allogeneic versus autologous transplantation (P<0.001), radiation-based preparative regimen (P=0.035) and recent period of transplantation (P<0.001); 2) in multivariate analysis: older age at transplant in quartiles (Odds Ratio (OR)=7.64, 95% CI: 3.73-15.64 for age >12.7 years and OR=5.36, 95% CI: 2.63-10.95 for age from 8.2 to 12.7 years compared to age < 4.7 years), acute myeloid leukemia (OR=3.23, 95% CI: 1.47-7.13), allogeneic graft (OR=4.34, 95% CI: 2.07-9.12 for alternative donors and OR=2.53, 95% CI: 1.2-5.33 for siblings, compared to autologous graft) and radiation-based conditioning regimen (OR=2.45, 95% CI: 1.09-5.53). Graft-versus-host disease was an additional risk factor for allogeneic graft recipients. In conclusion, IO is a frequent complication in pediatric long-term survivors after transplantation for acute leukemia, more frequently observed in older children, those transplanted from alternative donors or with graft-versus-host disease.
儿科中关于移植后铁过载（IO）的数据稀缺。我们开展了一项前瞻性多中心队列研究（儿童与青少年白血病队列研究），以确定384名童年期接受移植的急性白血病幸存者中IO的患病率及危险因素。IO（铁蛋白水平⩾350 ng/mL）的患病率为42.2%（95%置信区间37.2 - 47.2%）。与IO显著相关的因素有：1）单因素分析：移植时年龄较大（P<0.001）、异体移植与自体移植（P<0.001）、基于放疗的预处理方案（P=0.035）以及移植近期（P<0.001）；2）多因素分析：移植时年龄较大的四分位数（与年龄<4.7岁相比，年龄>12.7岁时比值比（OR）=7.64，95%置信区间：3.73 - 15.64；年龄在8.2至12.7岁时OR=5.36，95%置信区间：2.63 - 10.95）、急性髓系白血病（OR=3.23，95%置信区间：1.47 - 7.13）、异体移植物（与自体移植物相比，替代供体时OR=4.34，95%置信区间：2.07 - 9.12；同胞供体时OR=2.53，95%置信区间：1.2 - 5.33）以及基于放疗的预处理方案（OR=2.45，95%置信区间：1.09 - 5.53）。移植物抗宿主病是异体移植物受者的另一个危险因素。总之，IO是急性白血病移植后儿科长期幸存者中的常见并发症，在年龄较大的儿童、接受替代供体移植者或患有移植物抗宿主病者中更常观察到。
