An assessment of iron overload in children treated for cancer and nonmalignant hematologic disorders

Our goal was to assess the natural fate of iron overload (IO) following transfusions of packed red blood cells (PRBCs) in children treated for cancer and nonmalignant disorders according to the intensity level of their treatment. Sixty-six children were followed up from February 2010 to March 2013. The transfusion burden was compared between three treatment intensity groups assigned according to the Intensity of Treatment Rating Scale 3.0 (ITR-3). IO was assessed by serial measurements of serum ferritin (SF) (n = 66) and quantification of tissue iron by magnetic resonance imaging (MRI) (n = 12). Of the children studied, 36 % (24/66) received moderately intensive treatment (level 2), 21 % (14/66) received very intensive treatment (level 3), and 42 % (28/66) received the most intensive treatment (level 4). The number of PRBC (p = 0.016), the total transfused volume (p = 0.026), and transfused volume adjusted to body weight (p = 0.004) were significantly higher in the level 4 group. By the median follow-up time of 35.5 months (range 8–133), 21–29 % of patients (including level 2 and level 3 children) had SF >1,000 μg/l 1 year after cessation of transfusions. The slowest decrease of SF was observed in the level 4 group. Initial MRI examination demonstrated either mild or moderate IO in the liver and spleen. Repetitive MRI showed significant improvement in relaxation time between the initial and follow-up MRI performances in the liver (5.9 vs. 8.6 ms, p = 0.03) and the spleen (4.3 vs. 8.8 ms, p = 0.03). Conclusion: IO diminished over time, but in the level 4 patients, it was detectable for years after cessation of transfusions.