Evaluating Iron Overload in Survivors of Pediatric Cancer Público
Eason, Ashley (Spring 2019)
Published
Abstract
Background: Iron overload is a known complication in patients who receive multiple erythrocyte transfusions for chronic hematologic disease. Due to their disease process and treatment, some pediatric cancer patients develop anemia requiring supportive transfusions at frequent intervals. Currently the Children’s Oncology Group (COG) has established guidelines to obtain a ferritin for iron overload screening in patients who have undergone hematopoietic stem cell transplantation (HSCT); however, no guidelines exist for other patients. Since treatment options are available, successful screening may help prevent end organ damage from iron accumulation.
Objective: To analyze our childhood cancer survivor population to identify factors which increase the risk for development of iron overload.
Methods: We performed a retrospective cohort study of pediatric cancer patients inclusive of all malignant diagnoses from 2009-2015. Patients were identified from the cancer registry at Children’s Healthcare of Atlanta and the outcome iron overload was defined as ferritin value ≥ 500 ng/mL.
Results: We identified 2486 children with malignant diagnoses during our study period. Of these participants, 75% (1866/2486) received an erythrocyte transfusion and 11% (134/1186) of eligible patients had a screening ferritin level performed following completion of therapy. Iron overload was noted in 47% (61/130) of the screened patients at follow up. Increased number of erythrocyte transfusions (aOR 1.33 [95% CI: 1.19-1.49]) and older age at diagnosis (aOR 1.15 [95% CI: 1.04-1.32]) were associated with development of iron overload. In addition, higher intensity treatment rating (ITR) (aOR 26.91 [95%CI 3.04-239.20]) and earlier time to ferritin (aOR 0.95 [95%CI: 0.91-0.98]) after completion of therapy were found to be associated with the development of iron overload when controlling for additional covariates of interest.
Conclusion: Patients with greater treatment intensity and more erythrocyte transfusions are at risk to develop iron overload. We found that ITR is a useful clinical tool to identify patients who would benefit from iron overload screening. A minority of patients had confirmatory imaging with MRI Ferriscan (24/61), however, all imaging found excess iron accumulation in the liver. This demonstrates our institutional imaging threshold is too high and we are missing patients who would benefit from treatment for iron overload.
Table of Contents
A. INTRODUCTION.……………………………………………………………………………..1
B. BACKGROUND……………………………………………………………………………….3
C.METHODS……………………………………………………………………………………..8
D.RESULTS……………………………………………………………………………………..13
E. DISCUSSION/CONCLUSIONS………………………………………………………........17
F. REFERENCES……………………………………………………………………………….22
G.TABLES/FIGURES………………………………………………………………………......25
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