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Iron Overload and Hematopoetic Stem Cell Transplantation

Z. Yeğin,G. Sucak,T. Demirer

Published 2013 in Unknown venue

ABSTRACT

Hematopoietic stem cell transplantation (HSCT) is an established treatment modality with a curative potential in a variety of hematological disorders. Although remarkable advances in transplant immunology and supportive care allowed widespread use of HSCT, transplant related morbidity and mortality remain as a problem [1-7]. Early complications including si‐ nusoidal obstruction syndrome (SOS), hemorrhagic cystitis, engraftment syndrome, idio‐ pathic pneumonia syndrome (IPS), infections and graft versus host disease (GVHD) are the major causes of morbidity and non relapse mortality (NRM). High doses of radiotherapy and chemotherapy of the conditioning regimen have adverse effects on all organs and tis‐ sues of the recipient, which also triggers several early and late effects of variable intensity [1, 3, 5-8]. Iron overload (IO) is a relatively common condition in patients with hematological malignacies and HSCT recipients. Free iron which accompanies IO might contribute to the already existing prooxidant state in HSCT recipients by inducing the formation of reactive oxygen species (ROS). Tissue peroxidation and organ damage, as a consequence, contribute to the development of some early transplant complications [2, 4, 5, 9]. Increasing number of transplants performed each year and improved transplant techniques result in a rise in the number of long term survivors. The primary goal of HSCT is to cure the primary disease. However long term transplant related morbidity might be very challenging and might sig‐ nificantly impair the quality of life. Late effects might be the consequence of the direct toxici‐ ty of chemoradiotherapy and/or the immunologic complications mainly consisting of GVHD. Besides the secondary late effects including osteoporosis and dental caries, very late effects, namely cardiovascular toxicity considered as tertiary late effect may also occur. Among this wide spectrum of complications, IO has a substantial role as a contributor to liv‐

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