Effect of Liver and Heart Iron Overload Detected By MRI T2 * on HLA Matched HSCT in Child Patients with β-Thalassemia Major

Background

Most children with β-thalassemia major have iron overload which may have negative effect on hematopoietic stem cell transplantation. At present, the serum ferritin is used as an indicator of iron overload .However,since the distribution of iron in the organs of the body is not consistent, the serum ferritin can not exactly reflect the iron overload of important organs such as the liver and the heart .There are many international studies showing that MRI T2 * can accurately measure the iron load of the liver and the heart .In order to further clarify the effect of liver and heart iron overload on HLA matched HSCT among child patients with thalassemia and to provide the basis for clinical evaluation of patients with priority to transplantation,we compared liver and heart iron overload detected by MRI T2 * and serum ferritin with related events of transplantation.

Patients and method

81 child patients underwent liver and heart MRI T2 * tests.They were over 3 years old from April 2014 to December 2016 ,staying in our department ;they had had HLA matched allogeneic hematopoietic stem cell transplantation, and with β-thalassemia major, they were qualified to participate MRI detection .According to the test results,we calculated the liver and cardiac iron content, which is considered as the level of liver and heart iron overload. Next, it was compared with Serum Ferritin(SF),time of hematopoietic reconstruction,mortality rate, implantation rate and the morbidity of transplantation related complications such as graft versus host disease(GVHD),infection rate,autoimmune hemolysis,pancytopenia, hepatic veno-occlusive disease(VOD)and septicemia.

Results

SF and the liver T2 * were negative correlation (r=- 0.305, P= 0.305), and SF was correlated with the liver iron concent (r= 0.228, P= 0.228).SF was not correlated with cardiac iron content and heart T2 *.

Liver iron content was correlated with the time of hemoglobin implantation (r= 0.229, P=0.043), cardiac iron content was correlated with mortality rate (r=0.266, P=0.017) ,SF and implantation rate were negative correlation( r=-0.289, P=0.009),SF was correlated with the morbidity of septicemia( r=0.251, P=0.024),SF was correlated with the morbidity of pancytopenia( r=0.276, P=0.013).

Summary

Iron overload may have negative effect on HLA matched allogeneic hematopoietic stem cell transplantation among child patients with β-thalassemia major, it is necessary to evaluat SF, liver and heart iron overload before HSCT.