Effect Of Liver And Heart Iron Overload Detected By MRI On HLA Matched Hematopoietic Stem Cell Transplantation Among Child Patients With?-thalassemia Major

Background p-thalassemia is one of the most common genetic anemia in the world.Most children with ?-thalassemia major have iron overload which may have negative effect on hematopoietic stem cell transplantation.At present,the serum ferritin(SF)is used as an indicator of iron overload.However,since the distribution of iron in the organs of the body is not consistent,the serum ferritin can not exactly reflect the iron overload of important organs such as the liver and the heart.There are many international studies showing that MRI T2*can accurately measure the iron load of the liver and the heart.Objective In order to further clarify the effect of liver and heart iron overload on HLA matched HSCT among child patients with thalassemia and to provide the basis for clinical evaluation of patients with priority to transplantation,we compared liver and heart iron overload detected by MRI T2*and serum ferritin with related events of transplantation.Patients and methods 81 child patients with ?-thalassemia major had underwent liver and heart MRI T2*tests who was over 3 years old from April 2014 to December 2016 in our department undergoing HLA matched allogeneic hematopoietic stem cell transplantation,and could cooperate with MRI detection.According to the test results,we calculated the liver and cardiac iron content,which is considered as the level of liver and heart iron overload.Next,it was compared with age,SF,left ventricular ejection fraction(LVEF),BNP,CK-MB,time of hematopoietic reconstruction,mortality rate,implantation rate and the morbidity of transplantation related complications,such as graft versus host disease(GVHD),infection rate,autoimmune hemolysis,pancytopenia,hepatic veno-occlusive disease(VOD)and septicemia,stomatitis,virus infection,infectious diarrhea,pulmonary infection.Results Age was correlated with cardiac iron content(r=0.275,P=0.013),was negative correlated with LVEF(r=-0.225,P=0.043).SF and the liver T2*were negative correlation(r =-0.305,P = 0.006),and SF was correlated with the liver iron concent(r = 0.228,P = 0.04).SF,LVEF,BNP,CK-MB was not correlated with cardiac iron content and heart T2*.Liver iron content was correlated with the time of hemoglobin implantation(r = 0.229,P =0.043),cardiac iron content was correlated with mortality rate(r =0.266,P =0.017).SF and implantation rate were negative correlation(r=-0.289,P=0.009),SF was correlated with the morbidity of septicemia(r=0.251,P=0.024),SF was correlated with the morbidity of pancytopenia(r=0.276,P=0.013).Liver or heart MRI T2*,liver or cardiac iron concentration before transplantation was not different from after transplantation in statistics.Summary Most patients in this research had iron overload.Iron overload in organs was not uniform.For iron overload may have negative effect on HLA matched allogeneic hematopoietic stem cell transplantation among child patients with ?-thalassemia major:iron overload may be associated with implantation failure;iron overload may increase the risk of sepsis;the liver iron overload may prolong the time of hemoglobin implantation;cardiac iron concent is positively correlated with mortality.Liver and cardiac iron concent can be accurately detected by MRI before HSCT,and it is important to predict the result of transplantation.Especially cardiac iron concent detected by MRI can be used to predict mortality after transplantation.It is necessary to evaluat SF,liver and heart iron overload before HSCT.