Curci Debora, Braidotti Stefania, Paternuosto Gilda, Flamigni Anna, Schillani Giulia, Longo Antonella, De Vita Nicole, Maximova Natalia
Advanced Translational Diagnostic Laboratory, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy.
Department of Pediatrics, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy.
Nutrients. 2025 Jul 28;17(15):2462. doi: 10.3390/nu17152462.
Pediatric allogeneic hematopoietic stem cell transplantation (allo-HSCT) is complicated by iron overload and hypomagnesemia, both contributing to immune dysfunction and post-transplant morbidity. The combined impact of these metabolic disturbances on pediatric allo-HSCT outcomes remains unexplored. This study aims to determine whether hypomagnesemia can serve as a prognostic biomarker for delayed immune reconstitution and explores its interplay with iron overload in predicting post-transplant complications and survival outcomes. : A retrospective analysis was conducted on 163 pediatric allo-HSCT recipients. Serum magnesium levels were measured at defined intervals post-transplant, and outcomes were correlated with CD4+ T cell recovery, time to engraftment, incidence of graft-versus-host disease (GVHD), and survival within 12 months. Iron status, including siderosis severity, was evaluated using imaging and laboratory parameters obtained from clinical records. : Patients who died within 12 months post-transplant exhibited significantly lower magnesium levels. Hypomagnesemia was associated with delayed CD4+ T cell recovery, prolonged engraftment, and an increased risk of acute GVHD. A strong inverse correlation was observed between magnesium levels and the severity of siderosis. Iron overload appeared to exacerbate magnesium deficiency. Additionally, the coexistence of hypomagnesemia and siderosis significantly increased the risk of immune dysfunction and early mortality. No significant association was found with chronic GVHD. : Hypomagnesemia is a significant, early predictor of poor outcomes in pediatric allo-HSCT, particularly in the context of iron overload, underscoring the need for early intervention, including iron chelation and MRI, to improve outcomes.
儿童异基因造血干细胞移植（allo-HSCT）会并发铁过载和低镁血症，二者均会导致免疫功能障碍和移植后发病。这些代谢紊乱对儿童allo-HSCT结局的综合影响仍未得到探索。本研究旨在确定低镁血症是否可作为免疫重建延迟的预后生物标志物，并探讨其与铁过载在预测移植后并发症和生存结局方面的相互作用。：对163例儿童allo-HSCT受者进行回顾性分析。在移植后规定的时间间隔测量血清镁水平，并将结局与CD4+T细胞恢复、植入时间、移植物抗宿主病（GVHD）发生率以及12个月内的生存率相关联。使用从临床记录中获得的影像学和实验室参数评估铁状态，包括铁沉积严重程度。：移植后12个月内死亡的患者镁水平显著较低。低镁血症与CD4+T细胞恢复延迟、植入时间延长以及急性GVHD风险增加相关。观察到镁水平与铁沉积严重程度之间存在强烈的负相关。铁过载似乎会加重镁缺乏。此外，低镁血症和铁沉积并存显著增加了免疫功能障碍和早期死亡的风险。未发现与慢性GVHD有显著关联。：低镁血症是儿童allo-HSCT预后不良的重要早期预测指标，尤其是在铁过载的情况下，这突出了早期干预的必要性，包括铁螯合和磁共振成像，以改善结局。
