Iron overload in children undergoing cancer treatments

Authors

  • Maëlle de Ville de Goyet MD,

    Corresponding author
    1. Department of Paediatric Haematology and Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium
    2. Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
    • Correspondence to: Maëlle de Ville de Goyet, Department of Paediatric Haematology and Oncology, Cliniques universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium.

      E-mail: maelle.deville@uclouvain.be

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  • Stéphane Moniotte MD, PhD,

    1. Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
    2. Department of Paediatric Cardiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
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  • Annie Robert MSci, PhD,

    1. Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
    2. Pôle d'Epidémiologie et Biostatistique, Université catholique de Louvain, Brussels, Belgium
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  • Sophie Dupont MD,

    1. Department of Paediatric Haematology and Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium
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  • Christiane Vermylen MD, PhD,

    1. Department of Paediatric Haematology and Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium
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  • Francis Veyckemans MD,

    1. Department of Anesthesiology, Université catholique de Louvain, Brussels, Belgium
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  • Bénédicte Brichard MD, PhD

    1. Department of Paediatric Haematology and Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium
    2. Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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  • Conflict of interest: There is no conflict of interest.

Abstract

Background

Iron overload is responsible for severe morbidity and mortality in polytransfused patients. Although repeated blood transfusions are needed during the treatment of most cancers, pediatric patients are not routinely screened for subsequent iron overload.

Procedure

Seventy-five patients were identified as candidates for cancer treatment and enrolled prospectively in a yearly protocol including a cardiac and liver magnetic resonance imaging coupled with ferritin level measurements. Patients were divided into four groups using the intensity of treatment rating (ITR-3).

Results

Fifty-nine patients reached 1-year of follow-up and liver iron overload was found in up to 66% of them. Such overload correlated with the total volume of red blood cells transfused and persisted at least 2 years after the initiation of therapy. Moderate myocardial overload was also, but less frequently (14%), observed in these patients.

Conclusions

Our study demonstrated that severe liver iron overload as well as moderate myocardial iron overload can be found 1 year after cancer treatment and that this overload persists overtime. The patients with higher ITR and those who have received more than a liter of blood red cells per square meter, regardless of their diagnosis or ITR, are at risk of iron overload and should be screened carefully. Pediatr Blood Cancer 2013;60:1982–1987. © 2013 Wiley Periodicals, Inc.

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