Impact of iron overload on poor graft function after allo-HSCT in a patient with transfusion-dependent low-risk MDS: A case report and literature review

Rationale: Poor graft function (PGF) occurs in 5% to 27% of allogeneic hematopoietic stem cell transplantation (allo-HSCT) and is associated with high life-threatening complications. The etiology of PGF is complex and multifactorial, and iron overload (IOL) is considered as a predictive factor. Patient concern: A 45-years-old woman who was diagnosed as low-risk myelodysplastic syndrome in 2012 has been transfusion dependent and developed severe IOL. Diagnoses: Due to transfusion dependency and also ineffective erythropoiesis, this patient was diagnosed as IOL and developed PGF after allo-HSCT. Interventions: Deferasirox (20mg/kg/d) was administered regularly after allo-HSCT for 2 years. Outcomes: Hematopoiesis was gradually recovered during iron chelation therapy treatment after allo-HSCT and PGF was reverted. Lessons: IOL, as a prognostic factor for PGF, is a common problem in Transfusion dependent myelodysplastic syndrome patients undergoing HSCT. IOL issues should be considered at the time of diagnosis and throughout the treatment course for patients who are potential candidates for HSCT.

[1]  Tonghua Yang,et al.  Recent Advancements in Poor Graft Function Following Hematopoietic Stem Cell Transplantation , 2022, Frontiers in Immunology.

[2]  D. Ritchie,et al.  Clinical features, pathophysiology, and therapy of poor graft function post–allogeneic stem cell transplantation , 2021, Blood advances.

[3]  Jiaxi Zhou,et al.  Advances in the understanding of poor graft function following allogeneic hematopoietic stem-cell transplantation , 2020, Therapeutic advances in hematology.

[4]  Jingjing Xu,et al.  Iron overload as a risk factor for poor graft function following allogeneic hematopoietic stem cell transplantation , 2020, The Kaohsiung journal of medical sciences.

[5]  He Huang,et al.  The incidence, Risk factors, and Outcomes of Primary Poor Graft Function after Allogeneic Hematopoietic Stem Cell Transplantation. , 2019, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[6]  Y. Kong.  Poor graft function after allogeneic hematopoietic stem cell transplantation-an old complication with new insights☆. , 2019, Seminars in hematology.

[7]  Yu Wang,et al.  Prophylactic oral NAC reduced poor hematopoietic reconstitution by improving endothelial cells after haploidentical transplantation. , 2019, Blood advances.

[8]  I. Matsumura,et al.  Excessive Reactive Iron Impairs Hematopoiesis by Affecting Both Immature Hematopoietic Cells and Stromal Cells , 2019, Cells.

[9]  B. Cho,et al.  Improved survival outcomes and restoration of graft‐vs‐leukemia effect by deferasirox after allogeneic stem cell transplantation in acute myeloid leukemia , 2019, Cancer medicine.

[10]  S. Galimberti,et al.  Iron Overload after Hematopoietic Stem Cell Transplantation , 2018, Blood.

[11]  B. Leber,et al.  Iron overload in myelodysplastic syndromes: Evidence based guidelines from the Canadian consortium on MDS. , 2018, Leukemia research.

[12]  Yu Wang,et al.  Dysfunctional Bone Marrow Mesenchymal Stem Cells in Patients with Poor Graft Function after Allogeneic Hematopoietic Stem Cell Transplantation. , 2018, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[13]  M. Cappellini,et al.  Non‐transferrin‐bound iron and oxidative stress during allogeneic hemopoietic stem cell transplantation in patients with or without iron overload , 2018, American journal of hematology.

[14]  Yu Wang,et al.  N‐acetyl‐L‐cysteine improves bone marrow endothelial progenitor cells in prolonged isolated thrombocytopenia patients post allogeneic hematopoietic stem cell transplantation , 2018, American journal of hematology.

[15]  K. Götze,et al.  Enhanced labile plasma iron and outcome in acute myeloid leukaemia and myelodysplastic syndrome after allogeneic haemopoietic cell transplantation (ALLIVE): a prospective, multicentre, observational trial. , 2018, The Lancet. Haematology.

[16]  S. CİVRİZ BOZDAĞ,et al.  Graft failure after allogeneic hematopoietic stem cell transplantation. , 2018, Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis.

[17]  Jianda Hu,et al.  Iron Overload Results in Poor Graft Function after Allogeneic Hematopoietic Stem Cell Transplantation By Impairing Hematopoiesis , 2017 .

[18]  E. Hod,et al.  Iron Overload Decreases Engraftment of Mice Receiving Allogeneic or Syngeneic Bone Marrow Transplant , 2017 .

[19]  L. Wu,et al.  [Risk-factor analysis of poor graft function after allogeneic hematopoietic stem cell transplantation for severe aplastic anemia]. , 2017, Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi.

[20]  T. Tanaka,et al.  Association between pretransplant iron overload determined by bone marrow pathological analysis and bacterial infection , 2017, Bone Marrow Transplantation.

[21]  E. Fibach,et al.  Toxicity of iron overload and iron overload reduction in the setting of hematopoietic stem cell transplantation for hematologic malignancies. , 2017, Critical reviews in oncology/hematology.

[22]  E. Atilla,et al.  Current Review of Iron Overload and Related Complications in Hematopoietic Stem Cell Transplantation , 2017, Turkish journal of haematology : official journal of Turkish Society of Haematology.

[23]  Yu Wang,et al.  Atorvastatin enhances endothelial cell function in posttransplant poor graft function. , 2016, Blood.

[24]  Yu Wang,et al.  Increased reactive oxygen species and exhaustion of quiescent CD34-positive bone marrow cells may contribute to poor graft function after allotransplants , 2016, Oncotarget.

[25]  G. Goteri,et al.  Reversal of poor graft function with iron-chelating therapy after allogeneic transplantation for severe aplastic anemia , 2016, Leukemia and Lymphoma.

[26]  Xiao-hui Zhang,et al.  The bone marrow microenvironment is similarly impaired in allogeneic hematopoietic stem cell transplantation patients with early and late poor graft function , 2016, Bone Marrow Transplantation.

[27]  Yu-Hong Chen,et al.  The incidence, risk factors, and outcomes of primary poor graft function after unmanipulated haploidentical stem cell transplantation , 2015, Annals of Hematology.

[28]  A. Meng,et al.  ROS-mediated iron overload injures the hematopoiesis of bone marrow by damaging hematopoietic stem/progenitor cells in mice , 2013, Scientific Reports.

[29]  K. Ozawa,et al.  The bone marrow hematopoietic microenvironment is impaired in iron‐overloaded mice , 2014, European journal of haematology.

[30]  B. Ko,et al.  Guidelines for treating iron overload in myelodysplastic syndromes: a Taiwan consensus statement , 2014, International Journal of Hematology.

[31]  G. Visani,et al.  Deferasirox improves hematopoiesis after allogeneic hematopoietic SCT , 2014, Bone Marrow Transplantation.

[32]  Lei Ding,et al.  Endothelial and perivascular cells maintain haematopoietic stem cells , 2011, Nature.

[33]  M. Cazzola,et al.  Iron overload and iron chelation therapy in patients with myelodysplastic syndrome treated by allogeneic stem‐cell transplantation: Report from the working conference on iron chelation of the Gruppo Italiano Trapianto di Midollo Osseo , 2011, American journal of hematology.

[34]  A. Larocca,et al.  Boost of CD34+-selected peripheral blood cells without further conditioning in patients with poor graft function following allogeneic stem cell transplantation. , 2006, Haematologica.