Serum ferritin is a different predictor from transfusion history for allogeneic transplantation outcome in patients with severe aplastic anemia

Figures & data

Table 1. Basic characteristics between patients with different durations from diagnosis to transplantation.

	≤2 months (n = 45)	>2 months (n = 51)	p-value
Gender
Male	28 (62.2%)	26 (51.0%)	0.307
Female	17 (37.8%)	25 (49.0%)
Age	23.98 (11.59)	18.45(11.52)	0.023*
Disease severity
VSAA	40 (88.9%)	31 (60.8%)	0.002*
SAA	5 (11.1%)	20 (39.2%)
Treatment before SCT
CSA	33 (73.3%)	36 (70.6%)	0.020*
CSA + ATG	0 (0.0%)	7 (13.7%)
Others	12 (26.7%)	8 (15.7%)
SCT type
HLA-matched sibling SCT	38 (84.4%)	30 (58.8%)	0.007*
Alternative donor SCT	7 (15.6%)	21 (41.2%)
Source of stem cell
Peripheral blood	29 (64.4%)	40 (78.4%)	0.185
Bone marrow	12 (26.7%)	6 (11.8%)
Peripheral blood + bone marrow	4 (8.9%)	5 (9.8%)
Blood type
Matched	29 (64.4%)	35 (68.6%)	0.672
Mismatched	16 (35.6%)	16 (31.4%)
MNC transfusion	7.39 (2.86)	7.81(2.58)	0.448
Number of CD34 cells	3.11 (1.16)	3.45(1.43)	0.224

Note: VSAA: very severe aplastic anemia; SAA: severe aplastic anemia; SCT: stem cell transplantation; CSA: cyclosporine; ATG: antithymocyte globulin; HLA: human leukocyte antigen; MNC: mononuclear cells.

Data are shown as n (%) or mean (SD).

Table 2. Comparison of SF and its related parameters between patients with different duration of pre-HSCT.

	≤2months (n = 45)	>2months (n = 51)	p-value
SF (ng/ml)	643.33 (434.82)	1036.68 (792.52)	0.004*
RBC transfusion (units)	8.42 (7.90)	19.08 (17.06)	0.000*
SI	40.34 (12.37)	46.49 (13.34)	0.041*
UIBC	9.01 (10.65)	7.06 (9.88)	0.408
TIBC	49.35 (10.55)	53.56 (10.70)	0.088
ISAT (%)	82.20 (17.47)	88.11 (14.30)	0.113
sTfR	0.56 (0.22)	0.47 (0.36)	0.273
IL-6	94.07 (67.68)	58.74 (70.04)	0.027*

Note: SF: serum ferritin; RBC: red blood cell; SI: serum iron; UIBC: unsaturated iron binding capacity; TIBC: total iron binding capacity; ISAT: iron saturation ratio; sTfR: soluble transferrin receptor; IL-6, interleukin 6.

Data are shown as mean (SD).

Figure 1. Flow chart of the patients included in this study.

Figure 2. OS in patients with short-term and long-term pre-HSCT therapy. (a) Survival analysis of patients with high and low SF levels; (b) survival analysis of patients with transfusion of ≥20 or <20 U; (c) survival analysis of patients with high and low SF levels; (d) survival analysis of patients with transfusion of ≥20 or <20 U.

Table 3. Treatment outcome of patients with short-term pre-HSCT periods (≤2 months).

	Pre-HSCT ferritin		p-value	RBC Transfusion		p-value
	<1000 ng/ml (n = 38)	≥1000 ng/ml (n = 7)		<20 U (n = 39)	≥20 U (n = 6)
Rejection
No	34 (89.47%)	6 (85.71%)	1.000	35 (89.7%)	5 (83.3%)	0.529
Yes	4 (10.53%)	1 (14.29%)		4 (10.3%)	1 (16.7%)
ANC engraftment
≤2 weeks	28 (73.7%)	6 (85.7%)	0.663	29 (74.4%)	5 (83.3%)	1.000
>2 weeks	10 (26.3%)	1 (14.3%)		10 (25.6%)	1 (16.7%)
PLT engraftment
≤2 weeks	18 (47.4%)	4 (57.1%)	0.699	20 (51.3%)	2 (33.3%)	0.665
>2 weeks	20 (52.6%)	3 (42.9%)		19 (48.7%)	4 (66.7%)
RBC transfusion independence
≤2 weeks	22 (57.9%)	3 (42.9%)	0.682	23 (59.0%)	2 (33.3%)	0.383
>2 weeks	16 (42.1%)	4 (57.1%)		16 (41.0%)	4 (66.7%)
aGVHD
No	24 (63.2%)	4 (57.1%)	1.000	26 (66.7%)	2 (33.3%)	0.179
I-II	11 (28.9%)	3 (42.9%)	0.659	11 (28.2%)	3 (50%)	0.356
III-IV	3 (7.9%)	0 (0.0%)	1.000	2 (5.1%)	1 (16.7%)	0.356
cGVHD
No	26 (68.4%)	5 (71.4%)	1.000	27, 69.2%	4 (66.7%)	1.000
Localized	6 (15.8%)	0 (0.0%)	0.569	6, 15.4%	0 (0.0%)	0.576
Extensive	6 (15.8%)	2 (28.6%)	0.590	6, 15.4%	2 (33.3%)	0.286
Bacterial infection
No	18 (47.4%)	3 (42.9%)	1.000	20 (51.3%)	1 (16.7%)	0.193
II	1 (2.6%)	0 (0.0%)	1.000	1 (2.6%)	0 (0.0%)	1.000
III	17 (44.7%)	2 (28.6%)	0.681	15 (38.5%)	4 (66.7%)	0.377
IV	2 (5.3%)	2 (28.6%)	0.108	3 (7.7%)	1 (16.7%)	0.448
Fungal infection
No	29 (76.3%)	6 (85.7%)	1.000	29 (74.4%)	6 (100%)	0.312
III	9 (23.7%)	0 (0.0%)	0.315	9 (23.1%)	0 (0.0%)	0.323
IV	0 (0.0%)	1 (14.3%)	0.156	1 (2.6%)	0 (0.0%)	1.000
Viral infection
No	25 (65.8%)	4 (57.1%)	0.686	26 (66.7%)	3 (50.0%)	0.650
II	1 (2.6%)	0 (0.0%)	1.000	1 (2.6%)	0 (0.0%)	1.000
III	12 (31.6%)	3 (42.9%)	0.670	212 (30.8%)	3 (50.0%)	0.384

Note: ANC: absolute neutrophil count; PLT: platelet; RBC: red blood cell; aGVHD: acute graft versus host disease; cGVHD: chronic graft versus host disease.

Data are shown as n (%).

Table 4. Treatment outcome of patients with long-term pre-HSCT periods (>2 months).

	Pre-HSCT ferritin		p-value	Transfused RBC		p-value
	<1000 ng/ml (n = 31)	≥1000 ng/ml (n = 20)		<20 U (n = 28)	≥20 U (n = 23)
Rejection
No	27 (87.1%)	17 (85.0%)	1.000	25 (89.3%)	19 (82.6%)	0.687
Yes	4 (12.9%)	3 (15.0%)		3 (10.7%)	4 (17.4%)
ANC engraftment
≤2 weeks	22 (71.0%)	11 (55.0%)	0.368	18 (64.3%)	15 (65.2%)	1.000
>2 weeks	9 (29.0%)	9 (45.0%)		10 (35.7%)	8 (34.8%)
PLT engraftment
≤2 weeks	19 (61.3%)	8 (40.0%)	0.161	15 (53.6%)	12 (52.2%)	1.000
>2 weeks	12 (38.7%)	12 (60.0%)		13 (46.4%)	11 (47.8%)
RBC transfusion independence
≤2 weeks	23 (74.2%)	9 (45.0%)	0.044*	21 (75.0%)	11 (47.8%)	0.080
>2 weeks	8 (25.8%)	11 (55.0%)		7 (25.0%)	12 (52.2%)
aGVHD
No	15 (45.4%)	9 (45.0%)	1.000	17 (60.7%)	7 (30.4%)	0.048*
I-II	11 (35.5%)	10 (50.0%)	0.386	9 (32.1%)	12 (52.2%)	0.167
III-IV	5 (16.1%)	1 (5.0%)	0.384	2 (7.1%)	4 (17.4%)	0.390
cGVHD
No	22 (71.0%)	11 (55.0%)	0.368	21 (75.0%)	12 (52.2%)	0.141
Localized	3 (9.7%)	6 (30.0%)	0.129	5 (17.9%)	4 (17.4%)	1.000
Extensive	6 (19.4%)	3 (15.0%)	1.000	2 (7.1%)	7 (30.4%)	0.061
Bacterial infection
No	9 (29.0%)	7 (35.0%)	0.760	11 (39.3%)	58 (21.7%)	0.232
II	1 (3.2%)	0 (0.0%)	1.000	0 (0.0%)	1 (4.3%)	0.451
III	16 (51.6%)	11 (55.0%)	1.000	15 (53.6%)	12 (52.2%)	1.000
IV	5 (16.1%)	2 (10.0%)	0.690	2 (7.1%)	5 (21.7%)	0.221
Fungal infection
No	24 (77.4%)	14 (70.0%)	0.743	23 (82.1%)	15 (65.2%)	0.207
II	2 (6.5%)	0 (0.0%)	0.514	1 (3.6%)	1 (4.3%)	1.000
III	5 (16.1%)	6 (30.0%)	0.304	4 (14.3%)	7 (30.4%)	0.190
Viral infection
No	19 (61.3%)	9 (45%)	0.388	16 (57.1%)	12 (52.2%)	0.782
II	1 (3.2%)	0 (0.0%)	1.000	1 (3.6%)	0 (0.0%)	1.000
III	11 (35.5%)	11 (55.0%)	0.248	11 (39.3%)	11 (47.8%)	0.581

Note: ANC: absolute neutrophil count; PLT: platelet; RBC: red blood cell; aGVHD: acute graft versus host disease; cGVHD: chronic graft versus host disease.

Data are shown as n (%).

Table 5. Correlation analysis between SF and its related parameters in patients with different durations of pre-HSCT.

Short-term pre-HSCT period (≤2 months)			Long-term pre-HSCT period (>2 months)
	r	p-value		r	p-value
Transfused RBC units	0.388	0.011*	Transfused RBC units	0.510	0.001*
Infection before SCT	0.320	0.034*	sTfR	−0.543	0.000*

Note: HSCT: hematopoietic stem cell transplantation; SCT: stem cell transplantation; RBC: red blood cell; sTfR: soluble transferrin receptor.