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Pretransplant Serum Ferritin Levels and Outcomes after Myeloablative Allogeneic HSCT
Burcu Aslan Candır1, Sema Seçilmiş2, Samet Yaman3, Ersin BOZAN1, Bahar Uncu Ulu1, DİCLE İSKENDER1, Tuğçe Nur Yiğenoğlu1, Merih Kızıl Çakar2, Turgay Ulas1, MEHMET SINAN DAL1, Fevzi Altuntas1, Fevzi Altuntas41Department Of Hematology And Bone Marrow Transplantation Center, Ankara Dr. Abdurrahman Yurtaslan Oncology Training And Research Hospital, University Of Health Sciences, Ankara, Turkey2Department Of Hematology, Etlik City Hospital, Ankara, Turkey
3Department Of Hematology, Erol Olcok Training And Research Hospital, Çorum, Turkey
4School Of Medicine, Department Of Internal Medicine, Division Of Hematology, Ankara Yildirim Beyazit University, Ankara, Turkey
INTRODUCTION: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment for hematologic malignancies. Serum ferritin, an indicator of iron overload and systemic inflammation, has been suggested as a prognostic biomarker for post-transplant outcomes. The association between pre-transplant serum ferritin levels and post-transplant outcomes, particularly 100-day transplant-related mortality (TRM), was evaluated in acute leukemia patients who underwent their first allo-HSCT.
METHODS: We conducted a retrospective analysis of 170 adult patients with acute leukemia who received their initial myeloablative allo-HSCT during complete remission from 2015 to 2021 at a single institution. Patients were divided into two groups based on their ferritin levels before the transplant: <1500 µg/L and ≥1500 µg/L. The primary endpoint was 100-day TRM.
RESULTS: The mean age of the cohort was 39 years, and 60.6% had acute myeloid leukemia. The median level of ferritin was 1595 µg/L. The high-ferritin group exhibited significantly higher 100-day mortality (10.8% vs. 1.3%, p = 0.013) and 100-day TRM (8.6% vs. 1.3%, p = 0.041) than the low-ferritin group. Invasive fungal infections were more frequent in the high-ferritin group (11.8% vs. 3.9%, p=0.091). There were no notable differences in engraftment kinetics, cytomegalovirus reactivation, or graft-versus-host disease rates between the two groups.
DISCUSSION AND CONCLUSION: High pre-transplant serum ferritin correlates with elevated early TRM and a tendency toward increased rates of invasive fungal infections post-allo-HSCT. Ferritin may be used as a simple and accessible biomarker for initial risk stratification, facilitating enhanced infectious monitoring and possible iron-reducing interventions in high-risk patients. Future multicenter studies are necessary to confirm these results.
Keywords: ferritin, allogeneic stem cell transplantation, acute leukemia, transplant-related mortality, invasive fungal infection
Manuscript Language: English