open access

Vol 52, No 1 (2021)
Original research article
Submitted: 2021-02-08
Accepted: 2021-02-08
Get Citation

Impact of ferritin serum concentration on survival in children with acute leukemia: a long-term follow-up

Monika Łęcka, Krzysztof Czyżewski, Robert Dębski, Mariusz Wysocki, Jan Styczyński
DOI: 10.5603/AHP.2021.0008
·
Acta Haematol Pol 2021;52(1):54-60.

open access

Vol 52, No 1 (2021)
ORIGINAL RESEARCH ARTICLE
Submitted: 2021-02-08
Accepted: 2021-02-08

Abstract

Introduction: Nowadays, a significant number of children with acute leukemia can be cured. Iron overload, related to blood transfusions and its long-term complications, remains a problem. Elevated ferritin concentration is often observed in this group. The aim of this study was to evaluate the prognostic value of serum ferritin on long-term outcomes in children treated for acute leukemia. Material: We studied 71 patients treated for acute lymphoblastic (ALL) or myeloblastic (AML) leukemia between 2005 and 2011. Serum ferritin concentration, serum transaminases activity, lactic dehydrogenase and C-reactive protein levels (CRP) were analysed. Serum ferritin >1,000 µg/L was considered to be a marker of iron overload. Results: Thirty-seven patients (52.1%) had iron overload. Ferritin serum concentration correlated with alanine aminotranferase activity (p =0.001) and CRP concentration (p =0.012). A total of 19 (26.76%) patients died during follow-up. Ferritin level was higher in patients with AML vs. ALL. There was a significant difference in long-term outcomes with respect to high ferritin concentrations, both in patients undergoing haematopoietic cell transplantation (HCT) and in the non-HCT group. Conclusions: In both groups, patients with higher ferritin concentrations had worse overall and event-free survivals and a higher relapse incidence. Ferritin concentration >1,000 µg/L was the strongest determinant of long-term treatment outcome. Ferritin serum concentration >1,000 µg/L is an adverse prognostic marker of survival in children with acute leukemia treated with chemotherapy with or without HCT.

Abstract

Introduction: Nowadays, a significant number of children with acute leukemia can be cured. Iron overload, related to blood transfusions and its long-term complications, remains a problem. Elevated ferritin concentration is often observed in this group. The aim of this study was to evaluate the prognostic value of serum ferritin on long-term outcomes in children treated for acute leukemia. Material: We studied 71 patients treated for acute lymphoblastic (ALL) or myeloblastic (AML) leukemia between 2005 and 2011. Serum ferritin concentration, serum transaminases activity, lactic dehydrogenase and C-reactive protein levels (CRP) were analysed. Serum ferritin >1,000 µg/L was considered to be a marker of iron overload. Results: Thirty-seven patients (52.1%) had iron overload. Ferritin serum concentration correlated with alanine aminotranferase activity (p =0.001) and CRP concentration (p =0.012). A total of 19 (26.76%) patients died during follow-up. Ferritin level was higher in patients with AML vs. ALL. There was a significant difference in long-term outcomes with respect to high ferritin concentrations, both in patients undergoing haematopoietic cell transplantation (HCT) and in the non-HCT group. Conclusions: In both groups, patients with higher ferritin concentrations had worse overall and event-free survivals and a higher relapse incidence. Ferritin concentration >1,000 µg/L was the strongest determinant of long-term treatment outcome. Ferritin serum concentration >1,000 µg/L is an adverse prognostic marker of survival in children with acute leukemia treated with chemotherapy with or without HCT.

Get Citation

Keywords

ferritin, iron, leukemia, children, haematopoietic cell transplantation

About this article
Title

Impact of ferritin serum concentration on survival in children with acute leukemia: a long-term follow-up

Journal

Acta Haematologica Polonica

Issue

Vol 52, No 1 (2021)

Article type

Original research article

Pages

54-60

DOI

10.5603/AHP.2021.0008

Bibliographic record

Acta Haematol Pol 2021;52(1):54-60.

Keywords

ferritin
iron
leukemia
children
haematopoietic cell transplantation

Authors

Monika Łęcka
Krzysztof Czyżewski
Robert Dębski
Mariusz Wysocki
Jan Styczyński

References (20)
  1. Pui CH, Yang J, Bhakta N, et al. Global efforts toward the cure of childhood acute lymphoblastic leukaemia. Lancet Child Adolesc Health. 2018; 2(6): 440–454.
  2. Demidowicz E, Pogorzala M, Łęcka M, et al. Outcome of pediatric acute lymphoblastic leukemia: sixty years of progress. Anticancer Res. 2019; 39(9): 5203–5207.
  3. Balwierz W, Pawinska-Wasikowska K, Klekawka T, et al. Development of treatment and clinical results in childhood acute myeloid leukemia in Poland. Memo. 2012; 6(1): 54–62.
  4. Meyer SC, O’Meara A, Buser A, et al. Prognostic impact of posttransplantation iron overload after allogeneic stem cell transplantation. Biol Blood Marrow Transplant. 2013; 19(3): 440–444.
  5. Bernaudin F, Verlhac S, Latour RP, et al. Association of matched sibling donor hematopoietic stem cell transplantation with transcranial Doppler velocities in children with sickle cell anemia. JAMA. 2019; 321(3): 266–276.
  6. Halyabar O, Chang M, Schoettler M, et al. Calm in the midst of cytokine storm: a collaborative approach to the diagnosis and treatment of hemophagocytic lymphohistiocytosis and macrophage activation syndrome. Pediatr Rheumatol Online J. 2019; 17(1): 7.
  7. Uppuluri R, Swaminathan VV, Ramanan KM, et al. Haploidentical stem cell transplantation with post-transplant cyclophosphamide in fanconi anemia: improving outcomes with improved supportive care in India. Biol Blood Marrow Transplant. 2020; 26(12): 2292–2298.
  8. Morgenstern DA, Pötschger U, Moreno L, et al. Risk stratification of high-risk metastatic neuroblastoma: a report from the HR-NBL-1/SIOPEN study. Pediatr Blood Cancer. 2018; 65(11): e27363.
  9. Majhail NS, Lazarus HM, Burns LJ. Iron overload in hematopoietic cell transplantation. Bone Marrow Transplant. 2008; 41(12): 997–1003.
  10. Bazuave GN, Buser A, Gerull S, et al. Prognostic impact of iron parameters in patients undergoing allo-SCT. Bone Marrow Transplant. 2011; 47(1): 60–64.
  11. Bennett TD, Hayward KN, Farris RWD, et al. Very high serum ferritin levels are associated with increased mortality and critical care in pediatric patients. Pediatr Crit Care Med. 2011; 12(6): e233–e236.
  12. Kikuchi S, Kobune M, Iyama S, et al. Prognostic significance of serum ferritin level at diagnosis in myelodysplastic syndrome. Int J Hematol. 2012; 95(5): 527–534.
  13. Landier W, Armenian SH, Lee J, et al. Yield of screening for long-term complications using the children's oncology group long-term follow-up guidelines. J Clin Oncol. 2012; 30(35): 4401–4408.
  14. Michalak S. Perspectives for the therapy of anemia of chronic diseases. Acta Haematol Pol. 2020; 51(3): 125–132.
  15. Styczynski J. Infectious complications in children and adults with hematological malignancies. Acta Haematol Pol. 2019; 50(3): 167–173.
  16. Demidowicz E, Bartoszewicz N, Czyżewski K, et al. Acute non-hematological toxicity of intensive chemotherapy of acute lymphoblastic leukemia in children. Acta Haematol Pol. 2020; 51(3): 164–171.
  17. Styczyński J. ABC of viral infections in hematology: focus on herpesviruses. Acta Haematol Pol. 2019; 50(3): 159–166.
  18. Bartoszewicz N, Czyżewski K, Dębski R, et al. Efficacy of keratinocyte growth factor in prevention of oral mucositis in children undergoing allogeneic hematopoietic cell transplantation. Acta Haematol Pol. 2020; 51(3): 172–178.
  19. Styczyński J. Prophylaxis vs preemptive therapy in prevention of CMV infection: new insight on prophylactic strategy after allogeneic hematopoietic cell transplantation. Acta Haematol Pol. 2020; 51(1): 17–23.
  20. Brierley CK, Iniesta RR, Storrar N, et al. Hyperferritinemia in pediatric acute lymphoblastic leukemia. J Pediatr Hematol Oncol. 2017; 39(3): 238.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: journals@viamedica.pl