Impact of prohepcidin levels and iron parameters on early post-transplantation toxicities

Abstract

Objective: Recent reports show the adverse impact of pre-transplantation iron overload on the outcome of haematopoietic stem cell transplantation (HSCT). We studied the pre-transplantation serum iron (SI) parameters including prohepcidin levels — a regulatory peptide of systemic iron homeostasis — and their role in early post-transplantation toxicities in allogeneic HSCT recipients.Patients and methods: One hundred consecutive patients [36 women and 64 men; median age 27·5 years (range 16–63 years)] who underwent allogeneic HSCT between September 2003 and October 2007 at Gazi University were included in the study.Results: Pre-transplantation serum prohepcidin levels did not show correlation with SI parameters and interleukin-6 levels (P>0·05). Prohepcidin levels were inversely correlated with the National Cancer Institute grade of mucositis (P = 0·060), neutropenic fever (P<0·001), and the number of days with febrile neutropenia (P = 0·003). SI levels were correlated with the severity of hepatotoxicity (P = 0·015) while pre-transplantation transferrin saturation levels were positively correlated with the severity of hepatotoxicity (P = 0·055), pulmonary toxicity (P = 0·032), and sinusoidal obstruction syndrome (P = 0·049). Pre-transplantation serum ferritin levels were positively correlated with the development of sinusoidal obstruction syndrome (P = 0·010) and inversely correlated with the day of neutrophil engraftment (P = 0·012). Overall survival was 41·26% with a median follow-up time of 13 months (range 0·0–60 months). Pre-transplantation serum prohepcidin levels and iron overload were not associated with survival in Cox regression analysis.Conclusion: Our results suggest that pre-transplantation iron parameters and prohepcidin levels might predict some of the early post-transplantation toxicities, however, without an impact on overall survival.