Affiliation:
1. Division of Pediatric Hematology Oncology University of North Carolina School of Medicine Chapel Hill North Carolina USA
2. Children's Center for Cancer, Blood Diseases and Bone Marrow Transplantation Children's Hospital of Los Angeles Los Angeles California USA
3. Division of Pediatric Hematology Oncology Rady Children's Hospital San Diego California USA
4. Department of Pathology and Laboratory Medicine Children's Hospital Los Angeles Los Angeles California USA
5. Division of Cardiology Children's Hospital Los Angeles Los Angeles California USA
Abstract
AbstractBackgroundChildren treated for cancer are at risk for adverse effects of iron due to transfusions administered during prolonged marrow suppression, which may increase exposure to toxic forms of iron, extrahepatic iron accumulation, and long‐term organ damage.ObjectiveThis study aimed to characterize the severity and organ distribution of clinically significant, multisystem iron overload (IO) in an at‐risk cohort of pediatric cancer patients.MethodsThis was a retrospective, cross‐sectional study of childhood cancer patients who underwent a magnetic resonance imaging (MRI) due to clinical concern for IO. Data regarding cancer type and treatment, transfusion history, MRI and laboratory results, and treatment for IO were collected. Severity of IO was analyzed by non‐parametric tests with respect to clinical characteristics.ResultsOf the 103 patients, 98% of whom had a Cancer Intensity Treatment Rating (ITR‐3) of 3 or higher, 53% (54/102) had moderate or greater hepatic siderosis, 80% (77/96) had pancreatic siderosis, 4% (3/80) had cardiac siderosis, and 45% (13/29) had pituitary siderosis and/or volume loss. Pancreatic iron was associated with both cardiac (p = .0043) and pituitary iron (p = .0101). In the 73 off‐therapy patients, ferritin levels were lower (p = .0008) with higher correlation with liver iron concentration (LIC) (p = .0016) than on‐therapy patients. Fifty‐eight subjects were treated for IO.ConclusionIn this heavily treated cohort of pediatric cancer patients, more than 80% had extrahepatic iron loading, which occurs with significant exposure to toxic forms of iron related to decreased marrow activity in setting of transfusions. Further studies should examine the effects of exposure to reactive iron on long‐term outcomes and potential strategies for management.