The negative impact of high serum ferritin levels (SFL) before and after allogeneic hematopoietic cell transplantation (Allo-SCT) on outcomes is well recognized. However, it is ill-documented in adults receiving haploidentical SCT (Haplo-SCT) with post-transplant cyclophosphamide (PTCY) for hematological malignancies.
The main objective was to assess the impact of pre- and post-transplant SFL on overall (OS) and disease-free (DFS) survivals and non-relapse mortality (NRM) in patients receiving a Haplo-SCT with PTCY. The secondary objective was to identify factors associated with outcomes after transplant by comparing SFL with other parameters related to the status of patients or donors.
This multicentric retrospective study included 223 consecutive patients who received a Haplo-SCT with PTCY in 4 French centers (Nantes, Angers, Besançon, and Brest) between October 2013 and January 2020. The impact of SFL at different time points on OS, DFS and NRM was assessed based on receiver operating characteristic (ROC) curves.
With a median follow-up of 37.6 months (IQR: 23.5 – 51.0), 3-year OS, DFS, and NRM were 48.1±4%, 46.3±4%, and 30.0±3%, respectively. Pre-transplant SFL had no impact on outcomes, whatever the cut-off tested. Considering patients alive at 3 months (3M) post-transplant, SFL≥3500 µg/L at 3M was statistically significantly associated with worse 3-year OS (32.7±8.7% vs 53.4±7.2%, p=0.01) and DFS (30.1±8.2% vs 53.1±7.1%, p=0.008), with a trend for higher NRM (33.2±8.6% vs 17.6±5.4%, p=0.10). Similarly, high SFL (≥ 2700 µg/L) at 6 months (6M) post-transplant was associated with worse 3-year OS (56.1±9.1% vs 79.2±6.0%, p = 0.02), and DFS (53.6±8.7% vs 74.9±6.2%, p=0.01), with a trend for higher NRM (21.4±7.4% vs 8.2±4.0%, p=0.10). In multivariate analysis, high 3M and 6M SFL remained associated with lower OS and DFS with a trend for higher NRM.
Pre-transplant SFL appears to have no impact on outcomes in Haplo-SCT with PTCY, at variance to what is documented in the matched Allo-SCT setting. In contrast, in the haplotransplant setting, early post-SCT high SFL are associated with lower survivals, and a trend in higher NRM.

Copyright © 2021. Published by Elsevier Inc.