nach oben

Annals of Hematology

Erschienen in:

01.05.2013 | Review Article

The management of iron overload in allogeneic hematopoietic stem cell transplant (alloHSCT) recipients: Where do we stand?

verfasst von: Serdar Sivgin, Bulent Eser

Erschienen in: Annals of Hematology | Ausgabe 5/2013

Einloggen, um Zugang zu erhalten

Abstract

Iron overload (IO), primarily related to multiple red blood cell transfusions, is a relatively common complication in hematopoietic stem cell transplant (HSCT) recipients. Elevated pretransplant ferritin levels have been reported to increase the risk of non-relapse mortality following HSCT and might influence the risk of acute and chronic graft versus host disease. IO has been shown to be an important cause of mortality and morbidity in patients who have undergone alloHSCT (Armand et al., Blood 109:4586–4588, 2007; Kim et al., Acta Haematol 120:182–189, 2008; Kataoka et al., Biol Blood Marrow Transplant 15:195–204, 2009). We know that excessive iron accumulation results in tissue damage and organ failure, mainly as a result of the generation of free radicals that cause oxidative damage and organ dysfunction (e.g., hepatotoxicity, cardiotoxicity, and endocrine dysfunction) (Altes et al., Bone Marrow Transplantation 29: 987–989, 2002; Papanikolaou et al., Toxicol Appl Pharmac 202:199–211, 2005). In the last decade, efforts have been directed toward identifying alternative treatment for IO in alloHSCT recipients to maintain improved transplant outcomes.

Strasser SI, Kowdley KV, Sale GE, McDonald GB (1998) Iron overload in bone marrow transplant recipients. Bone Marrow Transplant 22:167–173PubMedCrossRef

Butt NM, Clark RE (2003) Autografting as a risk factor for persisting iron overload in long-term survivors of acute myeloid leukaemia. Bone Marrow Transplant 32:909–913PubMedCrossRef

Kataoka K, Nannya Y, Hangaishi A, Imai Y, Chiba S, Takahashi T, Kurokawa M (2009) Influence of pretransplantation serum ferritin on nonrelapse mortality after myeloablative and nonmyeloablative allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 15:195–204

Altes A, Remacha AF, Sureda MR, Briones J, Canals C, Brunet S, Sierra J, Gimferrer E (2002) Iron overload might increase transplant-related mortality in haemotopoietic stem cell transplantation. Bone Marrow Transplant 29:987–989

Papanikolaou G, Pantopoulos K (2005) Iron metabolism and toxicity. Toxicol Appl Pharmacol 202:199–211

Armand P, Kim HT, Cutler CS,Ho VT, Koreth J, Alyea EP, Soiffer RJ, Antin JH (2007) Prognostic impact of elevated pretransplantation serum ferritin in patients undergoing myeloablative stem cell transplantation. Blood 109:4586–8

Kim YR, Kim JS, Cheong JW, Song JW, Min YH (2008) Transfusion-associated iron overload as an adverse risk factor for transplantation outcome in patients undergoing reduced-intensity stem cell transplantation for myeloid malignancies. Acta Haematol 120:182–9

Kamble RT, Selby GB, Mims M, Kharfan-Dabaja MA, Ozer H,George JN (2006) Iron overload manifesting as apparent exacerbation of hepatic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 12:506–510

Majhail NS, Lazarus HM, Burns LJ (2008) Iron overload in hematopoietic cell transplantation. BoneMarrow Transplant 41:997–1003

10.

Evens AM, Mehta J, Gordon LI (2004) Rust and corrosion in hematopoietic stem cell transplantation: the problem of iron and oxidative stress. Bone Marrow Transplant 34:561–571

11.

Maertens J, Demuynck H, Verbeken EK, Zachée P, Verhoef GE, Vandenberghe P, Boogaerts MA (1999) Mucormycosis in allogeneic bone marrow transplant recipients: report of five cases and review of the role of iron overload in the pathogenesis. Bone Marrow Transplant 24:307–312PubMedCrossRef

12.

Miceli MH, Dong L, Grazziutti ML, Fassas A, Thertulien R, Van Rhee F, Barlogie B, Anaissie EJ (2006) Iron overload is a major risk factor for severe infection after autologous stem cell transplantation: a study of 367 myeloma patients. Bone Marrow Transplant 37:857–864PubMedCrossRef

13.

Gaziev J, Lucarelli G (2011) Hematopoietic stem cell transplantation for thalassemia. Curr Stem Cell Res Ther 6:162–169PubMedCrossRef

14.

Sivgin S, Baldane S, Kaynar L, Kurnaz F, Pala C, Sivgin H, Ozturk A, Cetin M, Unal A, Eser B (2012) Pretransplant serum ferritin level may be a predictive marker for outcomes in patients having undergone allogeneic hematopoietic stem cell transplantation. Neoplasma 59:183–190PubMedCrossRef

15.

Mahindra A, Sobecks R, Rybicki L, Pohlman B, Dean R, Andresen S, Kalaycio M, Sweetenham J, Bolwell B, Copelan E (2009) Elevated pretransplant serum ferritin is associated with inferior survival following nonmyeloablative allogeneic transplantation. Bone Marrow Transplant 44:767–768PubMedCrossRef

16.

Mahindra A, Bolwell B, Sobecks R, Rybicki L, Pohlman B, Dean R, Andresen S, Weetenham J, Kalaycio M, Copelan E (2009) Elevated pretransplant ferritin is associated with a lower incidence of chronic graft-versus-host disease and inferior survival after myeloablative allogeneic haematopoietic stem cell transplantation. Br J Haematol 146:310–6

17.

Carpenter CE, Mahoney AW (1992) Contributions of heme and non-heme iron to human nutritions. Crit Rev Food Sci Nutr 31:333–367PubMedCrossRef

18.

Gordon LI, Brown SG, Tallman MS, Rademaker AW, Weitzman SA, Lazarus HM, Kelley CH, Mangan C, Rubin H, Fox RM (1995) Sequential changes in serum iron and ferritin in patients undergoing high dose chemotherapy and radiation with autologous bone marrow transplantation: possible implications for treatment related toxicity. Free Rad Biol Med 18:383–389PubMedCrossRef

19.

Lipschitz DA, Cook JD, Finch CA (1974) A clinical evaluation of serum ferritin as an index of iron stores. N Engl J Med 290:1213–1216PubMedCrossRef

20.

Cazzola M, Della Porta MG, Malcovati L (2008) Clinical relevance of anemia and transfusion iron overload in myelodysplastic syndromes. Hematol Am Soc Hematol Educ Prog 2008:166–175CrossRef

21.

Finch CA, Huebers H (1982) Perspectives in iron metabolism. N Engl J Med 306:1520–1528PubMedCrossRef

22.

Tanner MA, He T, Westwood MA, Firmin DN, Pennell DJ, Thalassemia International Federation Heart T2* Investigators (2006) Multi-center validation of the transferability of the magnetic resonance T2* technique for the quantification of tissue iron. Haematologica 91(10):1388–1391PubMed

23.

McKay PJ, Murphy JA, Cameron S, Burnett AK, Campbell M, Tansey P, Franklin IM (1996) Iron overload and liver dysfunction after allogeneic or autologous bone marrow transplantation. Bone Marrow Transplant 17:63–66PubMed

24.

Tomas JF, Pinilla I, Garcia-Buey ML, García A, Figuera A, Gómez-García de Soria VGG, Moreno R, Fernández-Rañada JM (2000) Long-term liver dysfunction after allogeneic bone marrow transplantation: clinical features and course in 61 patients. Bone Marrow Transplant 26:649–655PubMedCrossRef

25.

Sucak GT, Yegin ZA, Ozkurt ZN, Aki SZ, Karakan T, Akyol G (2008) The role of liver biopsy in the workup of liver dysfunction late after SCT: is the role of iron overload underestimated? Bone Marrow Transplant 42:461–467PubMedCrossRef

26.

Ho GT, Parker A, MacKenzie JF, Morris AJ, Stanley AJ (2004) Abnormal liver function tests following bone marrow transplantation: aetiology and role of liver biopsy. Eur J Gastroenterol Hepatol 16:157–162PubMedCrossRef

27.

Ali S, Pimentel JD, Munoz J, Shah V, McKinnon R, Divine G, Janakiraman N (2012) Iron overload in allogeneic hematopoietic stem cell transplant recipients. Arch Pathol Lab Med 136:532–538PubMedCrossRef

28.

Emond MJ, Bronner MP, Carlson TH, Lin M, Labbe RF, Kowdley KV (1999) Quantitative study of the variability of hepatic iron concentrations. Clin Chem 45:340–346PubMed

29.

Sheth S (2003) SQUID biosusceptometry in the measurement of hepatic iron. Pediatr Radiol 33:373–377PubMed

30.

Dunscombe PB, Katz DE, Stacey AJ (1984) Some practical aspects of dual-energy CT scanning. Br J Radiol 57:82–87PubMedCrossRef

31.

Hazirolan T, Akpinar B, Unal S, Gümrük F, Haliloglu M, Alibek S (2008) Value of dual energy computed tomography for detection of myocardial iron deposition in thalassaemia patients: initial experience. Eur J Radiol 68:442–445PubMedCrossRef

32.

Yeh BM, Shepherd JA, Wang ZJ, Teh HS, Hartman RP, Prevrhal S (2009) Dual-energy and low-kVp CT in the abdomen. Am J Roentgenol 193:47–54CrossRef

33.

Wood JC (2007) Magnetic resonance imaging measurement of iron overload. Curr Opin Hematol 14:183–190PubMedCrossRef

34.

Mahindra A, Bolwell B, Sobecks R, Rybicki L, Pohlman B, Dean R, Andresen S, Sweetenham J, Kalaycio M, Copelan E (2008) Elevated ferritin is associated with relapse after autologous hematopoietic stem cell transplantation for lymphoma. Biol Blood Marrow Transplant 14:1239–1244PubMedCrossRef

35.

Petrikkos G, Drogari-Apiranthitou M (2011) Zygomycosis in ımmunocompromised non-haematological patients. Mediterr J Hematol Infect Dis 3:2011–2012

36.

Platzbecker U, Bornhäuser M, Germing U, Stumpf J, Scott BL, Kröger N, Schwerdtfeger R, Böhm A, Kobbe G, Theuser C, Rabitsch W, Valent P, Sorror ML, Ehninger G, Deeg HJ (2008) Red blood cell transfusion dependence and outcome after allogeneic peripheral blood stem cell transplantation in patients with de novo myelodysplastic syndrome (MDS). Biol Bone Marrow Transplant 14:1217–1225CrossRef

37.

Morado M, Ojeda E, Garcia-Bustos J, Aguado MJ, Arrieta R, Quevedo E, Navas A, Hernandez-Navarro F (2000) BMT: serum ferritin as risk factor for veno-occlusive disease of the liver. Prospective cohort study. Hematology 4:505–512PubMed

38.

Maradei SC, Maiolino A, de Azevedo AM, Colares M, Bouzas LF, Nucci M (2009) Serum ferritin as risk factor for sinusoidal obstruction syndrome of the liver in patients undergoing hematopoietic stem cell transplantation. Blood 6(114):1270–1275CrossRef

39.

Pullarkat V, Blanchard S, Tegtmeier B, Dagis A, Patane K, Ito J, Forman SJ (2008) Iron overload adversely affects outcome of allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 42:799–805PubMedCrossRef

40.

Kontoyiannis DP, Chamilos G, Lewis RE, Giralt S, Cortes J, Raad II, Manning JT, Han X (2007) Increased bone marrow iron stores is an independent risk factor for invasive aspergillosis in patients with high-risk hematologic malignancies and recipients of allogeneic hematopoietic stem cell transplantation. Cancer 110:1303–1306PubMedCrossRef

41.

Poutsiaka DD, Price LL, Ucuzian A, Chan GW, Miller KB, Snydman DR (2007) Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality. Bone Marrow Transplant 40:63–70PubMedCrossRef

42.

Gaziev J, Sodani P, Polchi P, Andreani M, Lucarelli G (2005) Bone marrow transplantation in adults with thalassemia treatment and long-term follow-up. Ann NY Acad Sci 1054:196–205PubMedCrossRef

43.

Gaziev D, Giardini C, Angelucci E, Polchi P, Galimberti M, Baronciani D, Erer B, Maiello A, Lucarelli G (1995) Intravenous chelation therapy during transplantation for thalassemia. Haematologica 80:300–304PubMed

44.

Alessandrino EP, Della Porta MG, Bacigalupo A, Malcovati L, Angelucci E, Van Lint MT, Falda M, Onida F, Bernardi M, Guidi S, Lucarelli B, Rambaldi A, Cerretti R, Marenco P, Pioltelli P, Pascutto C, Oneto R, Pirolini L, Fanin R, Bosi A (2010) Prognostic impact of pre-transplantation transfusion history and secondary iron overload in patients with myelodysplastic syndrome undergoing allogeneic stem cell transplantation: a GITMO study. Haematologica 95:476–484PubMedCrossRef

45.

Hunter RL, Bennett B, Towns M, Vogler WR (1984) Transferrin in disease II: defects in the regulation of transferrin saturation with iron contribute to susceptibility to infection. Am J Clin Pathol 81:748–853PubMed

46.

Blei F, Puder DR (1993) Yersinia enterocolitica bacteremia in a chronically transfused patient with sickle cell anemia. Case report and review of the literature. Am J Pediatr Hematol Oncol 15:430–434PubMed

47.

Lee AC, Ha SY, Yuen KY, Lau YL (1995) Listeria septicemia complicating bone marrow transplantation for Diamond–Blackfan syndrome. Pediatr Hematol Oncol 12:295–299PubMedCrossRef

48.

Bonsdorff VL, Sahlstedt L, Ebeling F, Ruutu T, Parkkinen J (2003) Apotransferrin administration prevents growth of Staphylococcus epidermidis in serum of stem cell transplant patients by binding of free iron. FEMS Immunol Med Microbiol 37:45–51CrossRef

49.

Sivgin S, Eser B, Bahcebasi S, Kaynar L, Kurnaz F, Uzer E, Pala C, Deniz K, Ozturk A, Cetin M, Unal A (2012) Efficacy and safety of oral deferasirox treatment in the posttransplant period for patients who have undergone allogeneic hematopoietic stem cell transplantation (alloHSCT). Ann Hematol 91:743–749PubMedCrossRef

50.

Park CH, Valore EV, Waring AJ, Ganz T (2001) Hepcidin, a urinary antimicrobial peptide synthesized in the liver. J Biol Chem 276:7806–7810PubMedCrossRef

51.

Nemeth E, Ganz T (2006) Regulation of iron metabolism by hepcidin. Annu Rev Nutr 26:323–342PubMedCrossRef

52.

Kanda J, Uchiyama T, Tomosugi N, Higuchi M, Uchiyama T, Kawabata H (2009) Oncostatin M and leukemia inhibitory factor increase hepcidin expression in hepatoma cell lines. Int J Hematol 90:545–552PubMedCrossRef

53.

Nemeth E, Tuttle MS, Powelson J, Vaughn MB, Donovan A, Ward DM, Ganz T, Kaplan J (2004) Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its internalization. Science 306:2090–2093PubMedCrossRef

54.

Preza GC, Ruchala P, Nemeth E, Ganz T (2010) Minihepcidins: small peptides involved in disulfide exchange with ferroportin act as agonists. FASEB J 24:1011

55.

Corradini E, Schmidt PJ, Meynard D, Garuti C, Montosi G, Chen S, Vukicevic S, Pietrangelo A, Lin HY, Babitt JL (2010) BMP6 treatment compensates for the molecular defect and ameliorates hemochromatosis in Hfe knockout mice. Gastroenterology 139:1721–1729PubMedCrossRef

56.

Ganz T, Nemeth E (2011) The hepcidin-ferroportin system as a therapeutic target in anemias and iron overload disorders. Hematology Am Soc Hematol Educ Program 2011:538–542PubMedCrossRef

57.

Preza GC, Ruchala P, Pinon R, Ramos E, Qiao B, Peralta MA, Sharma S, Waring A, Ganz T, Nemeth E (2011) Minihepcidins are rationally designed small peptides that mimic hepcidin activity in mice and may be useful for the treatment of iron overload. J Clin Invest 121:4880–4888PubMedCrossRef

58.

Ramos E, Ruchala P, Goodnough JB, Kautz L, Preza GC, Nemeth E, Ganz T (2012) Minihepcidins prevent iron overload in a hepcidin-deficient mouse model of severe hemochromatosis. Blood 120(18):3829–3836PubMedCrossRef

59.

Sasu BJ, Cooke KS, Arvedson TL, Plewa C, Ellison AR, Sheng J, Winters A, Juan T, Li H, Begley CG, Molineux G (2010) Antihepcidin antibody treatment modulates iron metabolism and is effective in a mouse model of inflammation- induced anemia. Blood 115:3616–3624PubMedCrossRef

60.

Babitt JL, Huang FW, Xia Y, Sidis Y, Andrews NC, Lin HY (2007) Modulation of bone morphogenetic protein signaling in vivo regulates systemic iron balance. J Clin Invest 117:1933–1939PubMedCrossRef

61.

Bowen D, Culligan D, Jowitt S, Kelsey S, Mufti G, Oscier D, Parker J, UK MDS Guidelines Group (2003) Guidelines for the diagnosis and therapy of adult myelodysplastic syndromes. Br J Haematol 120:187–200PubMedCrossRef

62.

Santini V, Alessandrino PE, Angelucci E, Barosi G, Billio A, Di Maio M, Finelli C, Locatelli F, Marchetti M, Morra E, Musto P, Visani G, Tura S, Italian Society of Hematology (2010) Clinical management of myelodysplastic syndromes: update of SIE, SIES, GITMO practice guidelines. Leuk Res 34:1576–1588PubMedCrossRef

63.

Alessandrino EP, Angelucci E, Cazzola M, Della Porta MG, Di Bartolomeo P, Gozzini A, Malcovati L, Pioltelli P, Simona Sica S, Bosi A (2011) Iron overload and iron chelation therapy in patients with myelodysplastic syndrome treated by allogeneic stem-cell transplantation: report from the working conference on iron chelation of the Gruppo Italiano Trapianto di Midollo Osseo. Am J Hematol 86:897–902PubMedCrossRef

64.

Busca A, Falda M, Manzini P, D’Antico S, Valfrè A, Locatelli F, Calabrese R, Chiappella A, D’Ardia S, Longo F, Piga A (2010) Iron overload in patients receiving allogeneic hematopoietic stem cell transplantation: quantification of iron burden by a superconducting quantum interference device (SQUID) and therapeutic effectiveness of phlebotomy. Biol Blood Marrow Transplant 16:115–122PubMedCrossRef

65.

Rizzo JD, Wingard JR, Tichelli A, Lee SJ, Van Lint MT, Burns LJ, Davies SM, Ferrara JL, Socié G (2006) Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation: joint recommendations of the European Group for Blood and Marrow Transplantation, the Center for International Blood and Marrow Transplant Research, and the American Society of Blood and Marrow Transplantation. Biol Blood Marrow Transplant 12:138–151PubMedCrossRef

66.

Angelucci E, Muretto P, Lucarelli G, Ripalti M, Baronciani D, Erer B, Galimberti M, Giardini C, Gaziev D, Polchi P (1997) Phlebotomy to reduce iron overload in patients cured of thalassemia by bone marrow transplantation. Italian Cooperative Group for Phlebotomy Treatment of Transplanted Thalassemia Patients. Blood 90:994–998PubMed

67.

Olivieri NF, Brittenham GM (1997) Iron-chelating therapy and the treatment of thalassemia. Blood 89:739–761PubMed

68.

Nisbet-Brown E, Olivieri NF, Giardina PJ, Grady RW, Neufeld EJ, Séchaud R, Krebs-Brown AJ, Anderson JR, Alberti D, Sizer KC, Nathan DG (2003) Effectiveness and safety of ICL670 in iron-loaded patients with thalassaemia: a randomised, double-blind, placebo- controlled, dose-escalation trial. Lancet 361:1597–1602PubMedCrossRef

69.

Borgna-Pignatti C, Rugolotto S, De Stefano P, Zhao H, Cappellini MD, Del Vecchio GC, Romeo MA, Forni GL, Gamberini MR, Ghilardi R, Piga A, Cnaan A (2004) Survival and complications in patients with thalassemia major treated with transfusion and deferoxamine. Haematologica 89:1187–1193PubMed

70.

Fu D, Richardson DR (2007) Iron chelation and regulation of the cell cycle:2 mechanisms of posttranscriptional regulation of the universal cyclin-dependent kinase inhibitor p21CIP1/WAF1 by iron depletion. Blood 110:752–761PubMedCrossRef

71.

Nurtjahja-Tjendraputra E, Fu D, Phang JM, Richardson DR (2007) Iron chelation regulates cyclin D1 expression via the proteasome: a link to iron deficiency-mediated growth suppression. Blood 109:4045–4054PubMedCrossRef

72.

Hider RC, Zhou T (2005) The design of orally active iron chelators. Ann N Y Acad Sci 1054:141–154PubMedCrossRef

73.

Ceci A, Baiardi P, Felisi M, Cappellini MD, Carnelli V, De Sanctis V, Galanello R, Maggio A, Masera G, Piga A, Schettini F, Stefàno I, Tricta F (2002) The safety and effectiveness of deferiprone in a large-scale, 3-year study in Italian patients. Br J Haematol 118:330–336PubMedCrossRef

74.

Cohen AR, Galanello R, Piga A, De Sanctis V, Tricta F (2003) Safety and effectiveness of long-term therapy with the oral iron chelator deferiprone. Blood 102:1583–1587PubMedCrossRef

75.

Cappellini MD, Cohen A, Piga A, Bejaoui M, Perrotta S, Agaoglu L, Aydinok Y, Kattamis A, Kilinc Y, Porter J, Capra M, Galanello R, Fattoum S, Drelichman G, Magnano C, Verissimo M, Athanassiou-Metaxa M, Giardina P, Kourakli-Symeonidis A, Janka-Schaub G, Coates T, Vermylen C, Olivieri N, Thuret I, Opitz H, Ressayre-Djaffer C, Marks P, Alberti D (2006) A phase 3 study of deferasirox (ICL670), a once-daily oral iron chelator, in patients with β-thalassemia. Blood 107:3455–3462PubMedCrossRef

76.

Porter J, Galanello R, Saglio G, Neufeld EJ, Vichinsky E, Cappellini MD, Olivieri N, Piga A, Cunningham MJ, Soulières D, Gattermann N, Tchernia G, Maertens J, Giardina P, Kwiatkowski J, Quarta G, Jeng M, Forni GL, Stadler M, Cario H, Debusscher L, Della Porta M, Cazzola M, Greenberg P, Alimena G, Rabault B, Gathmann I, Ford JM, Alberti D, Rose C (2008) Relative response of patients with myelodysplastic syndromes and other transfusion-dependent anaemias to deferasirox (ICL670): a 1-year prospective study. Eur J Haematol 80:168–176PubMed

77.

Vichinsky E, Onyekwere O, Porter J, Swerdlow P, Eckman J, Lane P, Files B, Hassell K, Kelly P, Wilson F, Bernaudin F, Forni GL, Okpala I, Ressayre-Djaffer C, Alberti D, Holland J, Marks P, Fung E, Fischer R, Mueller BU, Coates T (2007) A randomized comparison of deferasirox versus deferoxamine for the treatment of transfusional iron overload in sickle cell disease. Br J Haematol 136:501–508PubMedCrossRef

78.

Ibrahim AS, Gebermariam T, Fu Y, Lin L, Husseiny MI, French SW, Schwartz J, Skory CD, Edwards JE Jr, Spellberg BJ (2007) The iron chelator deferasirox protects mice from mucormycosis through iron starvation. J Clin Invest 117:2649–2657PubMedCrossRef

79.

Gardenghi S, Ramos P, Marongiu MF, Melchiori L, Breda L, Guy E, Muirhead K, Rao N, Roy CN, Andrews NC, Nemeth E, Follenzi A, An X, Mohandas N, Ginzburg Y, Rachmilewitz EA, Giardina PJ, Grady RW, Rivella S (2010) Hepcidin as a therapeutic tool to limit iron overload and improve anemia in β-thalassemic mice. Clin Invest 120:4466–4477CrossRef

80.

Rienhoff HY Jr, Viprakasit V, Tay L, Harmatz P, Vichinsky E, Chirnomas D, Kwiatkowski JL, Tapper A, Kramer W, Porter JB, Neufeld EJ (2011) A phase 1 dose-escalation study: safety, tolerability, and pharmacokinetics of FBS0701, a novel oral iron chelator for the treatment of transfusional iron overload. Haematologica 96:521–525PubMedCrossRef

Titel: The management of iron overload in allogeneic hematopoietic stem cell transplant (alloHSCT) recipients: Where do we stand?
verfasst von: Serdar Sivgin
Bulent Eser
Publikationsdatum: 01.05.2013
Verlag: Springer-Verlag
Erschienen in: Annals of Hematology / Ausgabe 5/2013
Print ISSN: 0939-5555
Elektronische ISSN: 1432-0584
DOI: https://doi.org/10.1007/s00277-013-1682-8

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2013

Morphology and quantitative composition of hematopoietic cells in murine bone marrow and spleen of healthy subjects

Pathogenesis, prevalence, and prognostic significance of cytopenias in chronic lymphocytic leukemia (CLL): a retrospective comparative study of 213 patients from a national CLL database of 1,518 cases

New missense homozygous mutation (Q270Ter) in the pyrimidine 5′ nucleotidase type I-related gene in two Indian families with hereditary non-spherocytic hemolytic anemia

Hematological abnormalities in severe anorexia nervosa

Cytological characterization of murine bone marrow and spleen hematopoietic compartments for improved assessment of toxicity in preclinical gene marking models