T2∗ MRI changes in the heart and liver of ex-thalassemic patients after hematopoietic stem cell transplantation

Abstract

Non-invasive methods like MRI-based techniques have been considered recently for assessment of liver and heart status in patients with thalassemia major (TM). The purpose of this study is to examine the alterations of hepatic and myocardial T2(∗) MRI values in TM patients after hematopoietic stem cell transplantation (HSCT) just before starting chelation therapy. The study included fifty-two TM patients with mean age of 7.6years who were referred to our center for HSCT. Before HSCT, patients underwent liver biopsy to determine fibrosis stage based on the Lucarelli classification. Hepatic and myocardial T2(∗) values before and 6months after transplantation were measured and analyzed. There was not a statistically significant increase in myocardial T2(∗) values after HSCT (p-value=0.35). Hepatic T2(∗) values significantly decreased after HSCT (p-value <0.001), showing the liver status has been worsened. In subgroup analysis, post-HSCT hepatic T2(∗) values (adjusted for baseline values) were significantly higher in patients with graft-versus-host disease (GvHD) compared to non-GvHD patients (p-value=0.04). The issue of iron overload is still remained as the main problem in ex-thalassemic patients after HSCT. We found T2(∗) MRI technique a quite beneficial method for following up the patients after transplantation. Obviously, planning large controlled trials associated with liver biopsy results after transplantation is required.