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Evolution of iron burden in acquired aplastic anemia: a cohort study of more than 3-year follow-up

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Abstract

Acquired aplastic anemia (AA) is the most common condition linked to transfusion dependence. We conducted a cohort study to explore patterns of the dynamic evolution of iron burden, and to identify the risk factors for iron overload (IO) in 550 AA patients. Of the participants, 13 % presented with IO when diagnosed, including 7 % of patients without a history of transfusion and 22 % of those receiving transfusions. Male patients [hazard ratio (HR) = 3.85, 95 % confidence interval (CI) 1.77–8.36], adults (HR = 3.04, 95 % CI 1.21–7.63), and patients with high transfusion burdens (more than eight units; HR = 11.30, 95 % CI 4.45–28.70) experienced a significantly higher risk of IO. Furthermore, we found a sharply increasing risk of IO within the first 2 years, especially in males, patients with large number of lifetime transfusions, and patients not responding to treatment. More interestingly, after transfusion independence, a significant seesaw effect between erythropoiesis and iron burden was not noted until 6 months later, which continued over 3 years. In contrast to female patients, children, and patients with lower transfusion burdens, male subjects, adults, and subjects with high transfusion burdens experienced a pattern of slow decline in iron burden. AA incurred a high risk of progression to IO and showed distinct patterns in the evolution of iron burden. In light of these data, we offer suggestions for decision-making regarding who should undergo iron chelation and when.

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Acknowledgments

The authors acknowledge all of the doctors and nurses at the Therapeutic Centre for Anemic Diseases and the team of researchers at the Clinical Laboratory Centre for their professional assistance. This work was supported by grants from the National Natural Science Foundation of China (No. 81370606, No. 81300388), the Peking Union Medical College Youth Fund (No. 3332013153).

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Severe Aplastic Anemia Studying Program, State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People’s Republic of China

    Peng Jin, Xingxin Li, Min Wang, Meili Ge, Jizhou Zhang, Jinbo Huang, Jing Zhang, Zhendong Huang, Neng Nie, Yingqi Shao, Jun Shi & Yizhou Zheng

  2. Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, People’s Republic of China

    Jinhuan Wang

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  1. Peng Jin
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  2. Jinhuan Wang
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  3. Xingxin Li
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  4. Min Wang
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  5. Meili Ge
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  7. Jinbo Huang
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  8. Jing Zhang
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  9. Zhendong Huang
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  10. Neng Nie
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  11. Yingqi Shao
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  12. Jun Shi
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  13. Yizhou Zheng
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Corresponding author

Correspondence to Jun Shi.

Additional information

P. Jin and J. Wang contributed equally in this study and should be considered co-first authors.

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Jin, P., Wang, J., Li, X. et al. Evolution of iron burden in acquired aplastic anemia: a cohort study of more than 3-year follow-up. Int J Hematol 101, 13–22 (2015). https://doi.org/10.1007/s12185-014-1708-6

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  • DOI: https://doi.org/10.1007/s12185-014-1708-6

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