祛铁治疗对伴铁过载骨髓增生异常综合征患者异基因造血干细胞移植的影响

OBJECTIVE: To investigate the effects of iron chelation therapy on hematopoietic reconstitution and related complications of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with myelodysplastic syndrome (MDS). METHODS: Various clinical parameters were analyzed retrospectively in 57 MDS patients with iron overload who received allo-HSCT. According to the level of serum ferritin (SF) before transplantation divided patients into two groups: the effective treatment group (SF<1 000 µg/L) and iron overload group (SF≥1 000 µg/L). RESULTS: ①30/57 cases were received iron chelation treatment, 27/57 patients didn't received iron chelating therapy before transplantation. 19/30 cases were in the effective treatment group, and the median SF level before transplantation was 561 (223–846) µg/L. 11/30 cases were in the iron overload group, and the median SF level before transplantation was 1 262 (1 100–2 352) µg/L. The median SF level was 1 540 (1 320–3 112) µg/L of 27 patients didn't received iron chelating therapy before transplantation. ②The rate of fully-engraftment in the effective treatment group and iron overload group was 19 cases (100.0%) and 34 cases (89.5%), myeloid reconstitution of 12(10–18) and 12(11–30) days respectively (P=0.441), and platelet reconstitution of 13(12–30) and 15 (10–32) days respectively (P=0.579). ③The infection risk rate of the effective treatment group was less than iron overload group [36.8% (7/19) vs 82.4% (28/34), P=0.002]. ④The incidence of aGVHD in effective treatment group was less than iron overload group [26.3%(5/19) vs 64.7%(22/34), P= 0.010]. All patients of the effective treatment group were Ⅰ/Ⅱ degree. 16 cases were Ⅰ/Ⅱ degree and 6 cases were Ⅲ/Ⅳ degree in the iron overload group. ⑤6 cases of iron overload group accepted iron chelation treatment early post-transplantation, and SF level decreased from 2 870 (2 205–3 580) µg/L to 1 270 (1 020–1 650) µg/L. ⑥The difference of median disease-free survival time between the effective treatment group and iron overload group was not statistically significant [28.9 (0.3–89.5) months vs 21.2(0.1–81.0) months, χ(2)=3.751, P=0.053]. CONCLUSION: Iron overload obviously increased transplant-related complications, and effective iron chelation therapy before transplantation significantly decreased the incidence of infection and degree of aGVHD, thereby reduced the non-relapse mortality in patients with MDS.