Iron Overload Management in Hematopoietic Stem Cell Transplantation
Summary
Iron overload is a frequent complication in patients undergoing haematopoietic stem cell transplantation (HSCT), arising primarily from repeated red cell transfusions and, in some disorders, from increased gastrointestinal iron absorption. Excess iron accumulates in the liver, heart and endocrine organs, promoting reactive oxygen species formation, tissue damage and heightened susceptibility to infections. In the peri-transplant period, elevated iron stores correlate with sinusoidal obstruction syndrome, delayed engraftment and increased non-relapse mortality. Assessment of iron burden relies on serum ferritin, transferrin saturation and quantitative imaging by magnetic resonance, with bone marrow iron grading as a semi-quantitative adjunct. Management strategies include iron chelation therapy with agents such as deferasirox or deferoxamine, and, once haematopoiesis is restored, therapeutic phlebotomy. Emerging data suggest that optimising iron balance before conditioning may improve overall survival and reduce relapse, while post-transplant chelation can support graft-versus-leukaemia effects and immune recovery. Multidisciplinary approaches that integrate early monitoring, tailored chelation schedules and phlebotomy protocols are essential to mitigate organ toxicity and enhance long-term transplant outcomes.
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Iron Overload Management in Hematopoietic Stem Cell Transplantation publication trend
The graph below shows the total number of articles in iron overload management in hematopoietic stem cell transplantation across all publications each year (not limited to Nature Index journals).
Technical terms
Serum ferritin: Intracellular iron storage protein whose circulating concentration reflects total body iron burden.
Hepcidin: Liver-derived peptide hormone that regulates iron absorption and release by binding to ferroportin.
Iron chelation therapy: Pharmacological removal of excess iron using agents that bind free iron for excretion.
Transfusion-related iron overload: Accumulation of iron in tissues due to chronic red blood cell transfusions.
Bone marrow iron stores: Semi-quantitative assessment of iron deposition in marrow macrophages and erythroid precursors.
References
- Iron Overload in Patients Undergoing Hematopoietic Stem Cell Transplantation. Advances in Hematology (2010).
- Soluble Hemojuvelin and Ferritin: Potential Prognostic Markers in Pediatric Hematopoietic Cell Transplantation. Cancers (2023).
- Association of Serum Ferritin Levels Before Start of Conditioning With Mortality After alloSCT – A Prospective, Non-interventional Study of the EBMT Transplant Complications Working Party. Frontiers in Immunology (2020).
- Improved survival outcomes and restoration of graft‐vs‐leukemia effect by deferasirox after allogeneic stem cell transplantation in acute myeloid leukemia. Cancer Medicine (2019).
- Iron Toxicity and Chelation Therapy in Hematopoietic Stem Cell Transplant. Transplantation and Cellular Therapy (2020).
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