Apostolidi Eirini A, Gamaletsou Maria N, Arapaki Maria, Asimakopoulos John V, Diamantopoulos Panagiotis, Zafeiratou Sofia, Kofteridis Diamantis, Pagoni Maria, Kotsopoulou Maria, Voulgarelis Michael, Sipsas Nikolaos V
Pathophysiology Department, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Hematology Department, General Hospital of Athens Laiko, 11527 Athens, Greece.
J Fungi (Basel). 2023 Jul 14;9(7):748. doi: 10.3390/jof9070748.
Iron plays an important role in the pathogenesis of infections, including invasive fungal infections (IFIs). Studies suggested that iron overload might represent an additional risk factor for IFIs among patients with hematological malignancies. We conducted a prospective, multi-center study amongst adult patients with newly diagnosed acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) in transformation to determine whether baseline iron overload as measured using the bone marrow iron store (BMIS) score is an independent risk factor for the development of IFIs. We also measured baseline serum iron and ferritin levels. A total of 98 patients were enrolled (76 with AML) and were followed for 12 months. Twenty-two patients developed IFI during the follow-up period (invasive aspergillosis = 16, candidemia = 5, mucormycosis = 1). A baseline BMIS score ≥ 3 indicated that iron overload was relatively common (38/98 patients, 38%), and its frequency was comparable between patients with no IFIs (31/76, 40.7%) and in those with IFIs (8/22, 36.4%). Univariate analysis showed that only the presence of AML was associated with increased risk for IFIs [OR (95% CI) 7.40 (1.05-325.42)]. Both univariate and multivariate analyses showed that an increased BMIS score (≥3) at baseline was not an independent risk factor for IFIs. Similarly, there was no difference in serum iron and ferritin between the two groups that had similar demographic characteristics. Indices of iron overload were not independent risk factors for IFIs in our cohort of Greek patients with newly diagnosed AML/MDS in transformation.
铁在包括侵袭性真菌感染（IFI）在内的感染发病机制中起重要作用。研究表明，铁过载可能是血液系统恶性肿瘤患者发生IFI的另一个危险因素。我们对新诊断的急性髓系白血病（AML）或转化中的骨髓增生异常综合征（MDS）成年患者进行了一项前瞻性多中心研究，以确定使用骨髓铁储存（BMIS）评分测量的基线铁过载是否是IFI发生的独立危险因素。我们还测量了基线血清铁和铁蛋白水平。共纳入98例患者（76例AML患者），随访12个月。22例患者在随访期间发生IFI（侵袭性曲霉病=16例，念珠菌血症=5例，毛霉病=1例）。基线BMIS评分≥3表明铁过载相对常见（38/98例患者，38%），其发生率在无IFI患者（31/76例，40.7%）和有IFI患者（8/22例，36.4%）之间相当。单因素分析显示，只有AML与IFI风险增加相关[比值比（95%可信区间）7.40（1.05 - 325.42）]。单因素和多因素分析均显示，基线BMIS评分增加（≥3）不是IFI的独立危险因素。同样，在具有相似人口统计学特征的两组患者中，血清铁和铁蛋白没有差异。在我们新诊断的转化期AML/MDS希腊患者队列中，铁过载指标不是IFI的独立危险因素。
