MRI-Based Liver Iron Content Predicts for Nonrelapse Mortality in MDS and AML Patients Undergoing Allogeneic Stem Cell Transplantation

作者：Wermke Martin^*; Schmidt Anne; Middeke Jan Moritz; Sockel Katja; von Bonin Malte; Schoenefeldt Claudia; Mair Sabine; Plodeck Verena; Laniado Michael; Weiss Guenter; Schetelig Johannes; Ehninger Gerhard; Theurl Igor; Bornhaeuser Martin; Platzbecker Uwe

来源：Clinical Cancer Research, 2012, 18(23): 6460-6468.

DOI：10.1158/1078-0432.CCR-12-1683

Purpose: Retrospective, surrogate marker-based studies have found inconsistent associations between systemic iron overload (SIO) and adverse outcome in patients undergoing allogeneic stem cell transplantation (allo-SCT). As a consequence, the impact of SIO in this context remains under debate. The aim of this study was to test whether the objective pretransplant quantification of liver-iron content (LIC) by magnetic resonance imaging (MRI) could circumvent these limitations and conclusively define the prognostic relevance of SIO. %26lt;br%26gt;Experimental Design: The correlation between pretransplant LIC and surrogate parameters as well as the impact of SIO on posttransplant outcome was assessed within an observational study of patients (n = 88) with either myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) undergoing allo-SCT. %26lt;br%26gt;Results: Ferritin levels of 1,000 ng/mL or more provided only poor specificity (31.8%) for predicting elevated LIC (%26gt;= 125 mu mol/g) and even higher thresholds (%26gt;= 2,500 ng/mL) lacked an association with nonrelapse mortality (NRM). In contrast, LIC 125 mu mol/g or more was a significant risk factor for NRM in uni- and multivariate analysis (HR = 2.98; P = 0.016). Multivariate Cox-regression further showed that LIC 125 mu mol/g or more was associated with a decreased overall survival (HR = 2.24, P = 0.038), whereas ferritin or transfusion burden were not. %26lt;br%26gt;Conclusions: SIO reflected by LIC is an independent negative prognostic factor for posttransplant outcome in patients with AML and MDS undergoing allo-SCT. Therefore, MRI-based LIC, and not interference-prone serum markers such as ferritin, should be preferred for pretransplant risk stratification and patient selection in future clinical trials. Clin Cancer Res; 18(23); 6460-8.

• 出版日期2012-12-1