Abstract

Iron overload may contribute to long-term complications in childhood cancer survivors. There are limited reports of assessment of tissue iron overload in childhood leukemia by magnetic resonance imaging (MRI). A cross-sectional, observational study in children treated for hematological malignancy was undertaken. Patients ≥6 months from the end of therapy who had received ≥5 red-cell transfusions were included. Iron overload was estimated by serum ferritin (SF) and T2*MRI. Forty-five survivors were enrolled among 431 treated for hematological malignancies. The median age at diagnosis was 7-years. A median of 8 red-cell units was transfused. The median duration from the end of treatment was 15 months. An elevated SF (>1,000 ng/ml), elevated liver iron concentration (LIC) and myocardial iron concentration (MIC) were observed in 5 (11.1%), 20 (45.4%), and 2 (4.5%) patients, respectively. All survivors with SF >1,000 ng/ml had elevated LIC. The LIC correlated with SF (p < 0.001). MIC lacked correlation with SF or LIC. Factors including the number of red-cell units transfused and duration from the last transfusion were associated with elevated SF (p = 0.001, 0.002) and elevated LIC (p = 0.012, 0.005) in multiple linear regression. SF >595 ng/ml predicted elevated LIC with a sensitivity of 85% and specificity of 91.6% (AUC 91.2%). A cutoff >9 units of red cell transfusions had poor sensitivity and specificity of 70% and 75% (AUC 76.6%) to predict abnormal LIC. SF >600 ng/ml is a robust tool to predict iron overload, and T2*MRI should be considered in childhood cancer survivors with SF exceeding 600 ng/ml.

摘要

铁过载可能导致儿童癌症幸存者出现长期并发症。通过磁共振成像 (MRI) 评估儿童白血病组织铁过载的报道有限。对接受血液恶性肿瘤治疗的儿童进行了一项横断面观察性研究。包括接受≥5 次红细胞输注的治疗结束后≥6 个月的患者。通过血清铁蛋白 (SF) 和 T2*MRI 评估铁过载。在接受血液恶性肿瘤治疗的 431 名患者中，有 45 名幸存者入选。诊断时的中位年龄为 7 岁。平均输注了 8 个红细胞单位。治疗结束后的中位持续时间为 15 个月。在 5 例 (11.1%)、20 例 (45. 4%）和 2 名（4.5%）患者。所有 SF >1,000 ng/ml 的幸存者都具有升高的 LIC。LIC 与 SF 相关（p  < 0.001）。MIC 与 SF 或 LIC 缺乏相关性。 在多元线性回归中，输注的红细胞单位数量和距离上次输血持续时间等因素与 SF 升高 ( p  = 0.001, 0.002) 和 LIC 升高 ( p = 0.012, 0.005) 相关。SF >595 ng/ml 预测 LIC 升高，灵敏度为 85%，特异性为 91.6% (AUC 91.2%)。大于 9 个单位的红细胞输注的临界值预测 LIC 异常的敏感性和特异性分别为 70% 和 75% (AUC 76.6%)。SF >600 ng/ml 是预测铁过载的有力工具，对于 SF 超过 600 ng/ml 的儿童癌症幸存者，应考虑 T2*MRI。