Prognostic Value for Survival of Serum Ferritin Levels Over Time After Allogeneic Hematopoietic Cell Transplantation

Abstract 4466

A significant association between iron overload prior to allogeneic hematopoietic cell transplantation (HCT) and worse prognosis following HCT has been reported. In most previous reports, the serum ferritin level before HCT was used as a surrogate marker of iron load. However, serum ferritin level is known to be increased by acute inflammation, including that due to infection, and/or active hematological diseases. The prognostic value of serum ferritin level has not been evaluated taking into consideration the influence of acute inflammation. In addition, little is known about changes in serum ferritin levels following HCT or the prognostic value for survival after HCT, particularly in the late period post HCT.

Here we comprehensively evaluated the impact of serum ferritin level after HCT as well as pre HCT on survival. We retrospectively studied 204 evaluable patients who had undergone HCT in our institute between February in 2004 and December in 2011, and who had available serum ferritin data pre HCT (median age 46, males 114 and females 90). The median follow-up period among surviving patients was 1023 days. We analyzed the impact of serum ferritin level pre HCT on overall survival after adjusting for various positive and negative acute phase reactants including haptoglobin, fibrinogen, CRP and serum albumin levels in multivariate analysis. On univariate analysis, serum ferritin level pre HCT significantly affected overall survival (ferritin per 100 ng/ml, HR: 1.003, p=0.008) and overall survival significantly worsened as serum ferritin level pre HCT increased (p for trend =0.01). However, after adjustment for haptoglobin or serum albumin levels, the relationship between serum ferritin pre HCT and survival was no longer statistically significant.