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Transfusional Hemosiderosis in Childhood Cancer Patients and Survivors
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  • Jacquelyn Baskin,
  • Susan Carson,
  • Julie Jaffray,
  • David Freyer,
  • John Wood,
  • Thomas Coates,
  • Christopher Denton
Jacquelyn Baskin
The University of North Carolina at Chapel Hill School of Medicine

Corresponding Author:jacquelyn_baskin@med.unc.edu

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Susan Carson
Children's Hospital Los Angeles Children's Center for Cancer and Blood Diseases
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Julie Jaffray
Rady Children's Hospital San Diego
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David Freyer
Children's Hospital Los Angeles Children's Center for Cancer and Blood Diseases
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John Wood
Children's Hospital Los Angeles
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Thomas Coates
Children's Hospital Los Angeles Children's Center for Cancer and Blood Diseases
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Christopher Denton
Children's Hospital Los Angeles Children's Center for Cancer and Blood Diseases
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Abstract

Background: Children treated for cancer are at risk of developing iron toxicity due to receiving red cell transfusions and myelosuppressive chemotherapy. Transfusions administered during prolonged episodes of marrow suppression may increase exposure to toxic, reactive forms of iron and thereby increase risk of extrahepatic iron accumulation and long-term organ damage. Objective: This study aimed to evaluate the severity and organ distribution of clinically significant iron overload through measurement of hepatic, cardiac, pancreatic, and pituitary iron deposition in an at-risk cohort of children and young adults treated for cancer. Methods: This retrospective study evaluated patients treated for any type of cancer who underwent an MRI due to clinical concern for evaluation of iron overload (n=103, 73 post-treatment). Data regarding cancer type and treatment, MRI and laboratory results, and treatment for iron overload were analyzed. Results: Over half (53%) of this sample had moderate or greater hepatic siderosis, 80% had pancreatic siderosis, and nearly half (45%) had pituitary siderosis and/or volume loss. Pancreatic iron was associated with both cardiac (p=0.0043) and pituitary iron (p=0.0101). Patients treated for acute myeloid leukemia or high-risk acute lymphoblastic leukemia had higher liver iron concentration (LIC) compared to other cancer types (median LIC 8.5 vs. 2.9 mg/g DLW, p=0.0011). Conclusion: Pediatric cancer patients are at risk for transfusional iron overload, with significant exposure to toxic forms of iron indicated by extrahepatic iron deposition (pancreas, heart and pituitary). Further studies should examine the effect of exposure to reactive iron on long-term outcomes and develop management recommendations.
Submitted to Pediatric Blood & Cancer
26 Jan 2024Review(s) Completed, Editorial Evaluation Pending
05 Feb 2024Editorial Decision: Revise Major
26 May 2024Reviewer(s) Assigned
03 Jul 2024Review(s) Completed, Editorial Evaluation Pending
10 Jul 2024Editorial Decision: Accept