American Journal of Pediatrics

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High Ferritin Before Transplant Increases Cytopenia Post-transplant in HLA Mismatched Hematopoietic Stem Cell Transplantation in β-Thalassemia Major

Received: Apr. 13, 2018    Accepted: May 24, 2018    Published: Jun. 14, 2018
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Abstract

The objective is to find out the causes of Cytopenia post-engraftment (CPE) in hematopoietic stem cell transplantation (HSCT) for patients with β-thalassemia major (β-TM). For this, 61 consecutive β-TM patients underwent 7/8 HLA matched HSCT from January 1, 2009 to June 30, 2015 were retrospectively analyzed. Thirty-eight patients suffered from CPE and the remainder (n=23) associated without CPE. The effect of pre-transplant ferritin (PTF) and recipient and donor age on CPE were analyzed in the two groups. The CPE was defined as white blood cell counts less than 3.0×109/L for four weeks or longer without infection of cytomegalovirus, human parvovirus B19 virus and Epstein-Barr virus. As result, in univariate analysis, PTF level was a high-risk factor for CPE and significant higher in CPE group than no-CPE group (3927.9 ± 1314.9 vs 2291.0 ± 994.4 ng/ml, p=0.000). The result was also proved by multi-factor binary regression analysis (p=0.001). The optimal value of PTF level by R language (R 2.15.2) is 2500ng/ml, which is cutoff value in the two groups. The current study showed high PTF level was a high-risk factor of CPE for β-TM patients underwent 7/8 HLA-matched HSCT. PTF should be reduced below 2500ng/L if the 7/8 matched HSCT must be done.

DOI 10.11648/j.ajp.20180402.13
Published in American Journal of Pediatrics ( Volume 4, Issue 2, June 2018 )
Page(s) 31-35
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Ferritin, Cytopenia, Thalassemia, HSCT

References
[1] Rachmilewitz, E.A. and P.J. Giardina, How I treat thalassemia. Blood, 2011. 118(13): p. 3479-88.
[2] Elborai, Y., A. Uwumugambi, and L. Lehmann, Hematopoietic stem cell transplantation for thalassemia. Immunotherapy, 2012. 4(9): p. 947-56.
[3] Modell, B., et al., Improved survival of thalassaemia major in the UK and relation to T2* cardiovascular magnetic resonance. J Cardiovasc Magn Reson, 2008. 10: p. 42.
[4] Ferrari, G., M. Cavazzana, and F. Mavilio, Gene Therapy Approaches to Hemoglobinopathies. Hematol Oncol Clin North Am, 2017. 31(5): p. 835-852.
[5] Baronciani, D., et al., Hemopoietic stem cell transplantation in thalassemia: a report from the European Society for Blood and Bone Marrow Transplantation Hemoglobinopathy Registry, 2000-2010. Bone Marrow Transplant, 2016. 51(4): p. 536-41.
[6] Gaziev, J., et al., Bone marrow transplantation for thalassemia from alternative related donors: improved outcomes with a new approach. Blood, 2013.
[7] Jaing, T.H., et al., Unrelated cord blood transplantation for thalassaemia: a single-institution experience of 35 patients. Bone Marrow Transplant, 2012. 47(1): p. 33-9.
[8] Bakhshi, S. and B. Biswas, Cytomegalovirus in hematological malignancies. Indian Pediatr, 2013. 50(2): p. 193-4.
[9] Hsu, W.Y., et al., Successful management of multilineage autoimmune cytopenia complicated with severe infection and deep vein thrombosis in a patient with Hodgkin lymphoma post-autologous hematopoietic stem cell transplantation. Pediatr Transplant, 2016. 20(1): p. 168-71.
[10] Waespe, N., U. Zeilhofer, and T. Gungor, Treatment-refractory multi-lineage autoimmune cytopenia after unrelated cord blood transplantation: remission after combined bortezomib and vincristine treatment. Pediatr Blood Cancer, 2014. 61(11): p. 2112-4.
[11] Teachey, D.T. and M.P. Lambert, Diagnosis and management of autoimmune cytopenias in childhood. Pediatr Clin North Am, 2013. 60(6): p. 1489-511.
[12] Li, C., et al., A novel conditioning regimen improves outcomes in beta-thalassemia major patients using unrelated donor peripheral blood stem cell transplantation. Blood, 2012. 120(19): p. 3875-81.
[13] Altes, A., et al., Iron overload might increase transplant-related mortality in haematopoietic stem cell transplantation. Bone Marrow Transplant, 2002. 29(12): p. 987-9.
[14] Holbro, A., M. Abinun, and T. Daikeler, Management of autoimmune diseases after haematopoietic stem cell transplantation. Br J Haematol, 2012. 157(3): p. 281-90.
[15] Bhatt, V., et al., Autoimmune hemolysis and immune thrombocytopenic purpura after cord blood transplantation may be life-threatening and warrants early therapy with rituximab. Bone Marrow Transplant, 2016. 51(12): p. 1579-1583.
[16] Thambiah, S.C., et al., Pre-transplantation serum ferritin as a prognostic marker in allogeneic haemopoietic stem cell transplant patients in a tertiary care hospital in Malaysia. Natl Med J India, 2016. 29(0970-258X (Print)): p. 136-140.
[17] Shaw, B.E., et al., The impact of HLA genotyping on survival following unrelated donor haematopoietic stem cell transplantation. Br J Haemato, 2010. 150(1365-2141 (Electronic)): p. 251-8.
[18] Oran, B., et al., Better allele-level matching improves transplant-related mortality after double cord blood transplantation. Haematologica, 2015. 100(10)(1592-8721 (Electronic)): p. 1361-70.
[19] de Witte, T., The role of iron in patients after bone marrow transplantation. Blood Rev, 2008. 22(1532-1681 (Electronic)): p. 22-8.
[20] Sucak, G.T., et al., Iron overload: predictor of adverse outcome in hematopoietic stem cell transplantation. Transplant Proc, 2010. 42 (5) (1873-2623 (Electronic)): p. 1841-8.
[21] Kataoka, K., et al., Influence of pretransplantation serum ferritin on nonrelapse mortality after myeloablative and nonmyeloablative allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant, 2009. 15(2)(1523-6536 (Electronic)): p. 195-204.
[22] Majhail, N.S., L.J. Lazarus Hm Fau - Burns, and L.J. Burns, Iron overload in hematopoietic cell transplantation. Bone Marrow Transplant, 2008 41(0268-3369 (Print)): p. 997-1003.
[23] Pullarkat, V., et al., Iron overload adversely affects outcome of allogeneic hematopoietic cell transplantation. Bone Marrow Transplant, 2008. 42(12)(1476-5365 (Electronic)): p. 799-805.
[24] Mahindra, A., et al., Elevated ferritin is associated with relapse after autologous hematopoietic stem cell transplantation for lymphoma. Biol Blood Marrow Transplant, 2008 14(1523-6536 (Electronic)): p. 1239-44.
[25] Recalcati, S., et al., New functions for an iron storage protein: the role of ferritin in immunity and autoimmunity. J Autoimmun, 2008. 30(0896-8411 (Print)): p. 84-9.
[26] Gray, C.P., P. Arosio P Fau - Hersey, and P. Hersey, Heavy chain ferritin activates regulatory T cells by induction of changes in dendritic cells. Blood, 2002. 99(9)(0006-4971 (Print)): p. 3326-34.
[27] Sakamoto, S., et al., Differing impacts of pretransplant serum ferritin and C-reactive protein levels on the incidence of chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. Int J Hematol, 2013. 97(1865-3774 (Electronic)): p. 109-16.
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    Liao Jianyun, Issa Moussa Mardo, Wen Jianyun, Zhou Xiaohui, Peng Zhiyong, et al. (2018). High Ferritin Before Transplant Increases Cytopenia Post-transplant in HLA Mismatched Hematopoietic Stem Cell Transplantation in β-Thalassemia Major. American Journal of Pediatrics, 4(2), 31-35. https://doi.org/10.11648/j.ajp.20180402.13

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    ACS Style

    Liao Jianyun; Issa Moussa Mardo; Wen Jianyun; Zhou Xiaohui; Peng Zhiyong, et al. High Ferritin Before Transplant Increases Cytopenia Post-transplant in HLA Mismatched Hematopoietic Stem Cell Transplantation in β-Thalassemia Major. Am. J. Pediatr. 2018, 4(2), 31-35. doi: 10.11648/j.ajp.20180402.13

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    AMA Style

    Liao Jianyun, Issa Moussa Mardo, Wen Jianyun, Zhou Xiaohui, Peng Zhiyong, et al. High Ferritin Before Transplant Increases Cytopenia Post-transplant in HLA Mismatched Hematopoietic Stem Cell Transplantation in β-Thalassemia Major. Am J Pediatr. 2018;4(2):31-35. doi: 10.11648/j.ajp.20180402.13

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  • @article{10.11648/j.ajp.20180402.13,
      author = {Liao Jianyun and Issa Moussa Mardo and Wen Jianyun and Zhou Xiaohui and Peng Zhiyong and Liu Huaying and Chen Libai and He Yuelin and Pei Fuyu and Wu Xuedong and Feng Xiaoqin and Bai Jing and Su Qingxia and Li Chunfu},
      title = {High Ferritin Before Transplant Increases Cytopenia Post-transplant in HLA Mismatched Hematopoietic Stem Cell Transplantation in β-Thalassemia Major},
      journal = {American Journal of Pediatrics},
      volume = {4},
      number = {2},
      pages = {31-35},
      doi = {10.11648/j.ajp.20180402.13},
      url = {https://doi.org/10.11648/j.ajp.20180402.13},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajp.20180402.13},
      abstract = {The objective is to find out the causes of Cytopenia post-engraftment (CPE) in hematopoietic stem cell transplantation (HSCT) for patients with β-thalassemia major (β-TM). For this, 61 consecutive β-TM patients underwent 7/8 HLA matched HSCT from January 1, 2009 to June 30, 2015 were retrospectively analyzed. Thirty-eight patients suffered from CPE and the remainder (n=23) associated without CPE. The effect of pre-transplant ferritin (PTF) and recipient and donor age on CPE were analyzed in the two groups. The CPE was defined as white blood cell counts less than 3.0×109/L for four weeks or longer without infection of cytomegalovirus, human parvovirus B19 virus and Epstein-Barr virus. As result, in univariate analysis, PTF level was a high-risk factor for CPE and significant higher in CPE group than no-CPE group (3927.9 ± 1314.9 vs 2291.0 ± 994.4 ng/ml, p=0.000). The result was also proved by multi-factor binary regression analysis (p=0.001). The optimal value of PTF level by R language (R 2.15.2) is 2500ng/ml, which is cutoff value in the two groups. The current study showed high PTF level was a high-risk factor of CPE for β-TM patients underwent 7/8 HLA-matched HSCT. PTF should be reduced below 2500ng/L if the 7/8 matched HSCT must be done.},
     year = {2018}
    }
    

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  • TY  - JOUR
    T1  - High Ferritin Before Transplant Increases Cytopenia Post-transplant in HLA Mismatched Hematopoietic Stem Cell Transplantation in β-Thalassemia Major
    AU  - Liao Jianyun
    AU  - Issa Moussa Mardo
    AU  - Wen Jianyun
    AU  - Zhou Xiaohui
    AU  - Peng Zhiyong
    AU  - Liu Huaying
    AU  - Chen Libai
    AU  - He Yuelin
    AU  - Pei Fuyu
    AU  - Wu Xuedong
    AU  - Feng Xiaoqin
    AU  - Bai Jing
    AU  - Su Qingxia
    AU  - Li Chunfu
    Y1  - 2018/06/14
    PY  - 2018
    N1  - https://doi.org/10.11648/j.ajp.20180402.13
    DO  - 10.11648/j.ajp.20180402.13
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 31
    EP  - 35
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20180402.13
    AB  - The objective is to find out the causes of Cytopenia post-engraftment (CPE) in hematopoietic stem cell transplantation (HSCT) for patients with β-thalassemia major (β-TM). For this, 61 consecutive β-TM patients underwent 7/8 HLA matched HSCT from January 1, 2009 to June 30, 2015 were retrospectively analyzed. Thirty-eight patients suffered from CPE and the remainder (n=23) associated without CPE. The effect of pre-transplant ferritin (PTF) and recipient and donor age on CPE were analyzed in the two groups. The CPE was defined as white blood cell counts less than 3.0×109/L for four weeks or longer without infection of cytomegalovirus, human parvovirus B19 virus and Epstein-Barr virus. As result, in univariate analysis, PTF level was a high-risk factor for CPE and significant higher in CPE group than no-CPE group (3927.9 ± 1314.9 vs 2291.0 ± 994.4 ng/ml, p=0.000). The result was also proved by multi-factor binary regression analysis (p=0.001). The optimal value of PTF level by R language (R 2.15.2) is 2500ng/ml, which is cutoff value in the two groups. The current study showed high PTF level was a high-risk factor of CPE for β-TM patients underwent 7/8 HLA-matched HSCT. PTF should be reduced below 2500ng/L if the 7/8 matched HSCT must be done.
    VL  - 4
    IS  - 2
    ER  - 

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Author Information
  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, China

  • Section