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Ferritin concentrations correlate to outcome of hematopoietic stem cell transplantation but do not serve as biomarker of graft-versus-host disease

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Abstract

Clinical presentation and laboratory data are often too unspecific to distinguish the onset or activity of graft-versus-host disease (GvHD) from infections or toxicity. Antigen-presenting cells such as monocytes/macrophages and dendritic cells are involved in GvHD pathogenesis after allogeneic hematopoietic stem cell transplantation (HSCT). To test whether ferritin, an iron storage marker and macrophage activation-linked acute-phase protein, represents a candidate biomarker for acute or chronic GvHD in pediatric HSCT, we retrospectively evaluated a 2-year follow-up data from 131 eligible consecutive patients with different malignant and nonmalignant diseases who underwent allogeneic HSCT. Thirteen patients (10 %) suffered from acute GvHD II–IV°, 18 (14 %) had limited, and 14 (11 %) had extensive chronic GvHD. In extension of previous studies in adults investigating pre-transplant ferritin, our data show that post-HSCT hyperferritinemia (analyzed on days 0, +30, +60, +100, +180, +360, and +720) was significantly associated with decreased long-term survival (p < 0.001–0.03) in children and adolescents. Increased ferritin concentrations were associated with number and timing of red blood cell transfusions and toxic or infectious multi-organ failure but did not show significant differences between patients without GvHD and with acute grades II–IV, limited, or extensive chronic GvHD. Thus, our data do not identify ferritin as specifically GvHD-linked biomarker; however, they support the prognostic value of ferritin levels for outcome after HSCT in children.

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Acknowledgments

This research was supported by the St. Anna Children’s Hospital and the Medical University of Vienna. The authors thank T. Waldhör for statistical advice (Institute of Epidemiology of the Medical University of Vienna).

Conflict of interest

All authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

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Authors and Affiliations

  1. Department of Pediatrics, St. Anna Children’s Hospital, Medical University of Vienna, Vienna, Austria

    M. Großekatthöfer, E. D. Güclü, A. Lawitschka, S. Matthes-Martin, G. Mann, M. Minkov, C. Peters & M. G. Seidel

  2. Pediatric Hematology Oncology, Medical University of Graz, Auenbruggerpl. 34/2, 8036, Graz, Austria

    M. G. Seidel

  3. Stem Cell transplantation Unit, Division of Pediatric Hematology Oncology, Department of Pediatrics and Adolescent Medicine, St. Anna Children’s Hospital, Medical University of Vienna, Kinderspitalgasse 6, A-1090, Vienna, Austria

    C. Peters

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  1. M. Großekatthöfer
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Correspondence to C. Peters or M. G. Seidel.

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Großekatthöfer, M., Güclü, E.D., Lawitschka, A. et al. Ferritin concentrations correlate to outcome of hematopoietic stem cell transplantation but do not serve as biomarker of graft-versus-host disease. Ann Hematol 92, 1121–1128 (2013). https://doi.org/10.1007/s00277-013-1737-x

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  • DOI: https://doi.org/10.1007/s00277-013-1737-x

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