Post-transplant ferritin level predicts outcomes after allogeneic hematopoietic stem cell transplant, independent from pre-transplant ferritin level.

Allogeneic hematopoietic stem cell transplantation (HCT) is associated with significant morbidity and mortality. Elevated pre-transplant ferritin level (ferritin) is reported to be associated with increased mortality following HCT. The present study attempted to determine whether post-transplant ferritin level (ferritin) is associated with outcomes post-HCT, especially in the subgroups which developed acute or chronic graft-versus-host disease (GVHD). Out of 229 patients with serum ferritin level measured post-HCT, median ferritin was 2178 ng/mL. Patients were stratified into low- or high-risk groups using recursive partitioning, based on ferritin (≤ 3169 vs > 3169 ng/mL) and ferritin (≤ 669 vs > 669 ng/mL). Compared to the low ferritin group, the high ferritin group had lower 3-year overall survival (OS) (40.0% vs 66.7%, p < 0.001) and higher non-relapse mortality (NRM) (48.6% vs 17.8%, p < 0.001), but no difference in relapse (10.5% vs 19.7%, p = 0.079). Multivariate analysis confirmed ferritin as an independent prognostic factor for OS (p = 0.001, HR = 2.323) and NRM (p < 0.001, HR = 3.905). However, ferritin did not stratify well for OS or NRM. Ferritin was also found to be an independent prognostic marker for OS and NRM in the subgroups which developed GVHD. In our cohort, high ferritin levels were significantly associated with decreased OS and increased NRM independent of ferritin or GVHD. Additional studies including larger sample sizes and prospective investigation are warranted to clarify the prognostic significance and pathophysiology of pre- and post-transplant hyperferritinemia.