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Deferasirox improves hematopoiesis after allogeneic hematopoietic SCT

Bone Marrow Transplantation volume 49, pages 585–587 (2014)Cite this article

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Iron overload is frequently observed before hematopoietic SCT (HSCT), due to multiple RBC transfusions, and is considered a significant contributor to treatment-related mortality.1 Little is known of the effects of iron overload on hematopoietic recovery after transplant. In fact, several patients present impaired recovery of hemopoiesis after transplant, with transfusion dependence and/or neutropenia and thrombocytopenia. All the same, the possible effect of iron chelators on the restoration of normal hemopoiesis after transplant is still unknown.

The role of iron overload after HSCT is not completely understood. Recent evidence suggests that increased liver iron concentration (LIC) measured with liver magnetic resonance (R2-magnetic resonance imaging) or liver biopsy do not correlate with survival or incidence of complications at 1-year post transplant.2, 3 However, in the recent past, an association between serum ferritin values before HSCT (used as a surrogate measure of iron overload) and an adverse outcome was shown,1 leading to the conclusion that hyperferritinemia has a detrimental effect on survival up to 5-year post transplant. Thus, interventions to reduce excessive body iron might be beneficial both before and after HSCT. In the peri-transplant period, BM suppression caused by chemotherapeutics substantially increases toxic nontransferrin-bound iron levels, because erythropoiesis is the main route of circulating iron utilization. An attractive explanation for the post transplantation iron overload in patients affected with GVHD is the deregulation of hepcidin production.4

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References

  1. Meyer SC, O’Meara A, Buser A, Tichelli A, Passweg JR, Stern M . Prognostic impact of post-transplantation iron overload after allogeneic stem cell transplantation. Biol Blood and Marrow Transpl 2013; 19: 440–444.

    Article  CAS  Google Scholar 

  2. Trottier BJ, Burns L, DeFor TE, Cooley S, Majhail NS . Association of iron overload with allogeneic hematopoietic cell transplantation outcomes: a prospective cohort study using R2-MRI-measured liver iron content. Blood 2013; 122: 1678–1684.

    Article  CAS  Google Scholar 

  3. Armand P, Sainvil MM, Kim HT, Rhodes J, Cutler C, Ho VT et al. Does iron overload really matter in stem cell transplantation? Am J Hematol 2012; 87: 569–572.

    Article  CAS  Google Scholar 

  4. Kanda J, Kawabata H, Chao N . Iron overload and allogeneic stem-cell transplantation. Expert Rev Hematol 2011; 4: 71–80.

    Article  CAS  Google Scholar 

  5. Messa E, Carturan S, Maffè C, Pautasso M, Bracco E, Roetto A et al. Deferasirox is a powerful NF-kB inhibitor in myelodysplastic cells and in leukemia cell lines acting independently from intracellular iron chelation and reactive oxygen species scavenging. Haematologica 2010; 95: 1308–1316.

    Article  CAS  Google Scholar 

  6. Ghoti H, Fibach E, Merkel D, Perez-Avaraham G, Grisariu S, Rachmilewitz EA . Changes in parameters of oxidative stress and free iron biomarkers during treatment with deferasirox in iron-overload patients with myelodysplastic syndrome. Haematologica 2010; 95: 1433–1434.

    Article  Google Scholar 

  7. Gardenghi S, Ramos P, Marongiu MF, Melchiori L, Breda L, Guy E et al. Hepcidin as a therapeutic tool to limit iron overload and improve anemia in beta-thalassemic mice. Nat Med 2010; 16: 177–182.

    Article  Google Scholar 

  8. Messa E, Cilloni D, Messa F, Arruga F, Roetto A, Saglio G . Deferasirox treatment improved the hemoglobin level and decreased transfusion requirements in four patients with the myelodysplastic syndrome and primary myelofibrosis. Acta Hematol 2008; 120: 70–74.

    Article  CAS  Google Scholar 

  9. Taoka K, Kumano K, Nakamura F, Hosoi M, Goyama S, Imai Y et al. The effect of iron overload and chelation on erythroid differentiation. Int J Hematol 2012; 95: 149–159.

    Article  CAS  Google Scholar 

  10. Forni GL, Podestà M, Musso M, Piaggio G, Musallam KM, Balocco M et al. Differential effects of the type of iron chelator on the absolute number of hematopoietic peripheral progenitors in patients with b-thalassemia major. Haematologica 2013; 98: 555–555.

    Article  CAS  Google Scholar 

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Acknowledgements

This study was supported in part by AIL Pesaro Onlus.

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Authors and Affiliations

  1. Hematology and Hematopoietic Stem Cell Centre, AORMN Marche Nord, Pesaro, Italy

    G Visani, B Guiducci, C Giardini, F Loscocco, T Ricciardi & A Isidori

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  1. G Visani
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  2. B Guiducci
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  3. C Giardini
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  4. F Loscocco
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  5. T Ricciardi
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  6. A Isidori
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Correspondence to G Visani.

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Visani, G., Guiducci, B., Giardini, C. et al. Deferasirox improves hematopoiesis after allogeneic hematopoietic SCT. Bone Marrow Transplant 49, 585–587 (2014). https://doi.org/10.1038/bmt.2013.213

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