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Serum ferritin is not a reliable predictor to determine iron overload in thalassemia major patients post‐hematopoietic stem cell transplantation
Author(s) -
Jarisch Andrea,
SalzmannManrique Emilia,
Cario Holger,
Grosse Regine,
Soerensen Jan,
Fischer Roland,
Schulz Ansgar,
Hammerstingl Renate,
Wunderlich Arthur,
Bader Peter
Publication year - 2018
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13169
Subject(s) - concordance , medicine , hematopoietic stem cell transplantation , thalassemia , ferritin , gastroenterology , anemia , concordance correlation coefficient , serum ferritin , beta thalassemia , transplantation , statistics , mathematics
Objective Iron overload (IO) in transfusion‐dependent anemia persists after hematopoietic stem cell transplantation (HSCT) and can cause long‐term organ damage. In many studies, the diagnosis of IO before and after HSCT is based on serum ferritin (SF) levels rather than on assessment of liver iron concentration (LIC) by MRI or SQUID. Method In a retrospective multicenter study, we analyzed the concordance for indication of iron depletion therapy and correlation between LIC and SF of 36 thalassemia patients after HSCT. LIC was determined either by MRI‐R2 (FerriScan®) or SQUID. Results The concordance between LIC and SF varies over time after transplant ( P = 0.011). The correlation between SF and LIC was strong in the first year (Spearman's rho 0.75; P < 0.001). In agreement, the concordance between SF and LIC concerning indication for treatment was close to 1 with an overall error rate ca. of 10%. In particular in the first year after HSCT, SF underestimates the degree of iron overload. However, in the longitudinal analysis since the second year post‐HSCT onward no association was found between LIC and SF ( P = 0.217). Furthermore, in the second year after HSCT, the overall error rate was 35%, whereas in the 3rd, 4th, and >4th year, it was 58%, 60%, and 25%, respectively. Conclusions Our data suggest serum ferritin is not a reliable predictor to determine iron overload in thalassemia patients after HSCT.