Impact of serum ferritin level before transplantation on the efficacy of allogeneic hematopoietic stem cell transplantation in patients with acute leukemia or intermediate-high-risk myelodysplastic syndrome

Zhu Lidan; Liu Jia; Gao Shichun; Wang Lu; Liu Huanfeng; Feng Yimei; Chen Ting; Yao Han; Liu Yuqing; Zhao Lu; Zhang Cheng; Gao Li; Kong Peiyan; Gao Lei; Zhang Xi

doi:10.13406/j.cnki.cyxb.004064

您当前的位置：

首页 >

文章列表页 >

Impact of serum ferritin level before transplantation on the efficacy of allogeneic hematopoietic stem cell transplantation in patients with acute leukemia or intermediate-high-risk myelodysplastic syndrome

Clinical research | 更新时间：2026-04-15

- Impact of serum ferritin level before transplantation on the efficacy of allogeneic hematopoietic stem cell transplantation in patients with acute leukemia or intermediate-high-risk myelodysplastic syndrome
- Journal of Chongqing Medical University Vol. 51, Issue 4, Pages: 563-570(2026)
- 作者机构：
  
  陆军军医大学第二附属医院血液病医学中心，重庆 400037
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.004064
  CLC： R552
- Received：08 December 2025，
  
  Revised：2026-01-13，
  
  Accepted：05 February 2026，
  
  Published：28 April 2026
- 稿件说明：
移动端阅览
朱丽丹，刘嘉，高世春，等.移植前血清铁蛋白水平对急性白血病和中高危骨髓增生异常综合征患者异基因造血干细胞移植疗效的影响[J].重庆医科大学学报，2026，51（4）：563-570.

Zhu Lidan,Liu Jia,Gao Shichun,et al.Impact of serum ferritin level before transplantation on the efficacy of allogeneic hematopoietic stem cell transplantation in patients with acute leukemia or intermediate-high-risk myelodysplastic syndrome[J].Journal of Chongqing Medical University,2026,51(4):563-570.
朱丽丹，刘嘉，高世春，等.移植前血清铁蛋白水平对急性白血病和中高危骨髓增生异常综合征患者异基因造血干细胞移植疗效的影响[J].重庆医科大学学报，2026，51（4）：563-570. DOI： 10.13406/j.cnki.cyxb.004064.

Zhu Lidan,Liu Jia,Gao Shichun,et al.Impact of serum ferritin level before transplantation on the efficacy of allogeneic hematopoietic stem cell transplantation in patients with acute leukemia or intermediate-high-risk myelodysplastic syndrome[J].Journal of Chongqing Medical University,2026,51(4):563-570. DOI： 10.13406/j.cnki.cyxb.004064.

摘要

目的

评价移植前血清铁蛋白水平（serum ferritin，SF）对急性白血病（acute leukemia，AL）/中高危-骨髓增生异常综合征（intermediate-high-risk myelodysplastic syndrome，IH-MDS）异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation，allo-HSCT）疗效的影响。

方法

回顾性分析本中心接收allo-HSCT的203例AL和IH-MDS患者，根据移植前SF水平分为SF<1 000 ng/mL，SF≥1 000 ng/mL 2组。比较2组患者供者植入、移植相关并发症、总生存（overall survival，OS），并进行OS危险因素分析。

结果

F≥1 000 ng/mL组患者的移植前红细胞输注量明显高于SF

1 000 ng/mL组，SF≥1 000 ng/mL组患者血小板植入不良，巨细胞病毒感染发生率明显增高；2组患者在重建时间、感染、复发未见明显差异；慢性移植物抗宿主病（chronic graft versus host disease，cGVHD）发生有受铁过载影响的趋势。单因素及多因素分析显示移植前疾病缓解状态、SF≥1 000 ng/mL、植入失败是OS及非复发死亡率（non-relapse mortality，NRM）独立危险因素。SF≥1 000 ng/mL、巨细胞病毒感染是导致植入不良或植入失败结局的危险因素。

结论

单因素及多因素显示移植前SF水平对AL和IH-MDS患者异基因造血干细胞移植术后OS产生影响，移植前应进行SF检测，可考虑作为重要的围移植风险分层和管理的重要标志物。

Abstract

Objective

To investigate the impact of serum ferritin（SF） level before transplantation on the efficacy of allogeneic hematopoietic stem cell transplantation（allo-HSCT） in patients with acute leukemia（AL） or intermediate-high-risk myelodysplastic syndrome（IH-MDS）.

Methods

A retrospective analysis was performed for 203 patients with AL or IH-MDS who underwent allo-HSCT in our center，and according to the level of SF before transplantation，they were divided into SF<1000 ng/mL group and SF≥1000 ng/mL group. The two groups were compared in terms of donor engraftment，transplantation-related complications，and overall survival （OS），and the risk factors for OS were analyzed.

Results

Compared with the SF<1000 ng/mL group，the SF≥1000 ng/mL group had a significantly higher volume of red blood cell transfusion before transplantation，as well as significant increases in the incidence rates of poor platelet engraftment and cytomegalovirus infection，while there were no significant differences between the two groups in time to hematopoietic reconstitution，infection，and recurrence. However，chronic graft-versus-host disease tended to be affected by iron overload. The univariate and multivariate analyses showed that disease remission before transplantation，SF≥1000 ng/mL，and graft failure were independent risk factors for OS and non-relapse mortality. SF≥1000 ng/mL and cytomegalovirus infection were risk factors for poor graft function or graft failure.

Conclusion

Univariate and multivariate analyses show that SF level before transplantation may affect OS after allo-HSCT in patients with AL or IH-MDS，and thus it should be measured before transplantation. It may be used as an important marker for peri-transplantation risk stratification and management.

关键词

Keywords

references

Döhner H ， Estey E ， Grimwade D ， et al . Diagnosis and management of AML in adults：2017 ELN recommendations from an international expert panel [J ] . Blood ， 2017 ， 129 （ 4 ）： 424 - 447 .

Moukalled NM ， El Rassi FA ， Temraz SN ， et al . Iron overload in patients with myelodysplastic syndromes： An updated overview [J ] . Cancer ， 2018 ， 124 （ 20 ）： 3979 - 3989 .

Busterud K ， Remberger M ， Bentsen PT ， et al . Allogeneic stem cell transplantation for acute myeloid leukaemia 2005-22 [J ] . Tidsskr Nor Laegeforen ， 2025 ， 145 （ 12 ）： 1 - 12 .

Wu XQ ， Lin KN ， Chen MM ， et al . Iron overload as a risk factor for poor graft function following allogeneic hematopoietic stem cell transplantation [J ] . Kaohsiung J Med Sci ， 2020 ， 36 （ 10 ）： 825 - 833 .

刘媛，杨同华 . β-地中海贫血患者铁过载对免疫系统的影响及治疗建议 [J ] . 中国实验血液学杂志， 2025 ， 33 （ 5 ）： 1546 - 1550 .

Liu Y ， Yang TH . The impact of iron overload on the immune system in patients with β-thalassemia and treatment recommendations-review [J ] . Journal of Experimental Hematology ， 2025 ， 33 （ 5 ）： 1546 - 1550 .

Zhang XY ， Shi YY ， Huang Y ， et al . Serum ferritin is a different predictor from transfusion history for allogeneic transplantation outcome in patients with severe aplastic Anemia [J ] . Hematology ， 2018 ， 23 （ 5 ）： 291 - 298 .

Armand P ， Kim HT ， Cutler CS ， et al . Prognostic impact of elevated pretransplantation serum ferritin in patients undergoing myeloablative stem cell transplantation [J ] . Blood ， 2007 ， 109 （ 10 ）： 4586 - 4588 .

中华医学会血液学分会/中国医师协会血液科医师分会 . 铁过载诊断与治疗的中国专家共识 [J ] . 中华血液学杂志， 2011 ， 32 （ 8 ）： 572 - 274 .

Chinese Society of Hematology/Chinese Medical Doctor Association ， Hematology Branch . A Chinese expert panel consensus statement on diagnosis and treament of iron overload [J ] . Chin J Hematol ， 2011 ， 32 （ 8 ）： 572 - 574 .

Gao L ， Liu J ， Zhang YQ ， et al . Low incidence of acute graft-versus-host disease with short-term tacrolimus in haploidentical hematopoietic stem cell transplantation [J ] . Leuk Res ， 2017 ， 57 ： 27 - 36 .

Zhou M ， Li TY ， Zhang P ， et al . Herombopag for the treatment of persistent thrombocytopenia following hematopoietic stem cell transplantation [J ] . Ann Hematol ， 2024 ， 103 （ 5 ）： 1697 - 1704 .

Tang FF ， Sun YQ ， Mo XD ， et al . Incidence，risk factors，and outcomes of primary prolonged isolated thrombocytopenia after haploidentical hematopoietic stem cell transplant [J ] . Biol Blood Marrow Transplant ， 2020 ， 26 （ 8 ）： 1452 - 1458 .

Zhao YM ， Gao F ， Shi JM ， et al . Incidence，risk factors，and outcomes of primary poor graft function after allogeneic hematopoietic stem cell transplantation [J ] . Biol Blood Marrow Transplant ， 2019 ， 25 （ 9 ）： 1898 - 1907 .

Kanda J ， Mizumoto C ， Ichinohe T ， et al . Pretransplant serum ferritin and C-reactive protein as predictive factors for early bacterial infection after allogeneic hematopoietic cell transplantation [J ] . Bone Marrow Transplant ， 2011 ， 46 （ 2 ）： 208 - 216 .

Zhang LY ， Xiong YY ， Liao MY ， et al . Risk factors of primary poor graft function after allogeneic hematopoietic stem cell transplantation in patients with myeloid malignancies [J ] . Zhongguo Shi Yan Xue Ye Xue Za Zhi ， 2024 ， 32 （ 6 ）： 1875 - 1881 .

Zhang YF ， Wang Y ， Ma RZ ， et al . Impact of platelet transfusion refractoriness in the first 30 days post-hematopoietic stem cell transplantation on outcomes of patients with myelodysplastic syndrome [J ] . Front Immunol ， 2024 ， 15 ： 1437176 .

黄　蕾，付　蓉 . 铁过载影响骨髓造血特点及机制研究进展 [J ] . 中华血液学杂志， 2019 ， 40 （ 8 ）： 709 - 712 .

Huang L ， Fu R . Research progress of characteristics and mechanisms of iron overload affecting bone marrow hematopoiesis [J ] . Chin J Hematol ， 2019 ， 40 （ 8 ）： 709 - 712 .

Franke GN ， Kubasch AS ， Cross M ， et al . Iron overload and its impact on outcome of patients with hematological diseases [J ] . Mol Aspects Med ， 2020 ， 75 ： 100868 .

Liu HL ， Yang N ， Meng S ， et al . Iron chelation therapy for myelodysplastic syndrome：a systematic review and meta-analysis [J ] . Clin Exp Med ， 2020 ， 20 （ 1 ）： 1 - 9 .

中国医师协会外科医师分会肥胖和糖尿病外科专家工作组 . 减重手术相关贫血管理策略中国专家共识（2024版） [J ] . 中华消化外科杂志， 2024 ， 23 （ 2 ）： 179 - 187 .

Obesity and Diabetes Surgery Expert Working Group of Surgeons Branch of Chinese Medical Doctor Association . Chinese expert consensus on the management strategy of anemia related to bariatric surgery （2024 edition） [J ] . Chin J Dig Surg ， 2024 ， 23 （ 2 ）： 179 - 187 .

Ko BS ， Chang MC ， Chiou TJ ， et al . Long-term safety and efficacy of deferasirox in patients with myelodysplastic syndrome，aplastic Anemia and other rare Anemia in Taiwan [J ] . Hematology ， 2019 ， 24 （ 1 ）： 247 - 254 .

Angelucci E ， Pilo F . Management of iron overload before，during，and after hematopoietic stem cell transplantation for thalassemia major [J ] . Ann N Y Acad Sci ， 2016 ， 1368 （ 1 ）： 115 - 121 .

曾　枞，陈　旭，华　娟，等 . 祛铁治疗改善恶性血液病患者造血干细胞移植后造血功能的临床分析 [J ] . 第三军医大学学报， 2021 ， 43 （ 21 ）： 2302 - 2306 .

Zeng C ， Chen X ， Hua J ， et al . Iron chelation therapy improves hematopoiesis in patients with hematological malignancy after hematopoietic stem cell transplantation [J ] . J Third Mil Med Univ ， 2021 ， 43 （ 21 ）： 2302 - 2306 .

Zheng QQ ， Zhao YS ， Guo J ， et al . Iron overload promotes mitochondrial fragmentation in mesenchymal stromal cells from myelodysplastic syndrome patients through activation of the AMPK/MFF/Drp1 pathway [J ] . Cell Death Dis ， 2018 ， 9 ： 515 .

Zheng QQ ， Zhao YS ， Guo J ， et al . Iron overload promotes erythroid apoptosis through regulating HIF-1a/ROS signaling pathway in patients with myelodysplastic syndrome [J ] . Leuk Res ， 2017 ， 58 ： 55 - 62 .

Zhu LD ， Liu J ， Kong PY ， et al . Analysis of the efficacy and safety of avatrombopag combined with MSCs for the treatment of thrombocytopenia after allogeneic hematopoietic stem cell transplantation [J ] . Front Immunol ， 2022 ， 13 ： 910893 .

Vanoaica L ， Richman L ， Jaworski M ， et al . Conditional deletion of ferritin h in mice reduces B and T lymphocyte populations [J ] . PLoS One ， 2014 ， 9 （ 2 ）： e89270 .

Virtanen JM ， Itälä-Remes MA ， Remes KJ ， et al . Prognostic impact of pretransplant iron overload measured with magnetic resonance imaging on severe infections in allogeneic stem cell transplantation [J ] . Eur J Haematol ， 2013 ， 91 （ 1 ）： 85 - 93 .

Pullarkat V ， Blanchard S ， Tegtmeier B ， et al . Iron overload adversely affects outcome of allogeneic hematopoietic cell transplantation [J ] . Bone Marrow Transplant ， 2008 ， 42 （ 12 ）： 799 - 805 .

Khandelwal P ， Ibrahimova A ， Lane A ， et al . Abatacept improves posttransplant survival and reduces endothelial injury syndromes in β-thalassemia major [J ] . Blood Adv ， 2025 ， 9 （ 24 ）： 6370 - 6379 .

Wang Y ， Chang YJ ， Chen J ， et al . Consensus on the monitoring，treatment，and prevention of leukaemia relapse after allogeneic haematopoietic stem cell transplantation in China： 2024 update [J ] . Cancer Lett ， 2024 ， 605 ： 217264 .

Kolloch L ， Berning P ， Albring JC ， et al . Immune reconstitution in AML and MDS patients undergoing allogeneic hematopoietic cell transplantation （allo-HCT） with treosulfan- or TBI-based conditioning [J ] . Bone Marrow Transplant ， 2025 ， 60 （ 11 ）： 1533 - 1536 .

Cattoni A ， Capitoli G ， Casagranda S ， et al . Iron overload following hematopoietic stem cell transplantation： prevalence，severity，and management in children and adolescents with malignant and nonmalignant diseases [J ] . Transplant Cell Ther ， 2023 ， 29 （ 4 ）： 271 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Efficacy of blinatumomab as a bridge therapy for allogeneic hematopoietic stem cell transplantation in treatment of minimal residual disease-positive B-lineage acute lymphoblastic leukemia

RAP hormone-free regimen in the treatment of moderate to severe bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation：a single-center retrospective analysis

Latent class analysis of behavioral characteristics of children with acute leukemia and associated influencing factors

SERUM FERRITIN IN RELATION TO THE CLINICAL COURSE IN ADULTS WITH ACUTE LEUKEMIA

FAT regiment for patients with relapsed,refractory acute leukemia

Related Author

Gao Lei

Liu Jia

Zhu Lidan

Gao Shichun

Liu Huanfeng

Wang Lu

Zhang Cheng

Gao Li

Related Institution

Jinfeng Laboratory，The Second Affiliated Hospital of Army Medical University

Department of Hematology，The Affiliated Hospital of University of Electronic Science and Technology of China/Sichuan People’s Hospital

Department of Hematology，Chengdu Dongli Hospital

Outpatient Department

Department of Nursing

⁰