Evaluation of Post-Transplant Iron Chelation Therapy in Allogeneic Hematopoietic Stem Cell Transplant

Background

Peri-transplant iron overload (IOL) has been associated with increased non-relapse morbidity and mortality in patients receiving hematopoietic stem cell transplant (HSCT). Iron chelation therapy (ICT) with deferoxamine or deferasirox, and phlebotomy remain the major therapeutic options for reducing IOL in HSCT recipients, though the role of ICT in these patients, particularly in the post-transplant period, has not been clearly defined. The aim of this study was to evaluate the impact of post-transplant ICT on outcomes up to day +100 in allogeneic HSCT, and to assess the tolerability of post-transplant ICT.

Methods

A retrospective medical record review of 29 patients who underwent allogeneic HSCT from March 2009 to October 2011 at a 779-licensed bed, urban academic medical center was conducted. Inclusion criteria were age ≥ 18 years and serum ferritin level ≥ 1000 ng/mL within 3 months prior to transplant. Exclusion criteria were mismatched or cord blood transplant, and ICT initiated in the pre-transplant period or after day +50. Patients were divided into 2 groups: those who received ≥ 1 dose of deferoxamine or deferasirox post-transplant up to day +50 (ICT group), and those who had never received ICT (non-ICT group). The primary endpoint was clinically significant liver dysfunction up to day +100.

Results

Of the 29 patients evaluated, 22 were in the non-ICT group and 7 in the ICT group (6 received deferoxamine 1000 mg IV daily, 1 received deferasirox 2000 mg orally daily; median duration of ICT, 24 days). There were no statistically significant differences between the groups in demographic or transplant characteristics, though there was a longer median time from diagnosis to transplant (417 vs. 238 days, p=0.37) and a higher median pre-transplant ferritin level (2910 vs. 1673 ng/mL, p=0.38) in the ICT group compared to the non-ICT group. Four patients experienced clinically significant liver dysfunction, with 3 patients (13.6%) in the non-ICT group and 1 patient (14.3%) in the ICT group (p=0.99). There were no significant differences in other post-transplant outcomes evaluated, including change in ferritin level, bloodstream infection, and death. Of the 7 ICT patients, 71.4% experienced acute kidney injury that required interruption or discontinuation of ICT.

Conclusions

ICT in the immediate post-transplant period did not improve post-transplant outcomes and was not well tolerated. Alternative strategies for the administration of pre- or peri-transplant ICT in HSCT recipients are recommended.