Insidious iron burden in pediatric patients with acute lymphoblastic leukemia.

BACKGROUND: A significant iron burden may occur after only 10 blood transfusions in patients with hematologic disorders. Children with acute lymphoblastic leukemia (ALL) routinely receive blood transfusions during therapy, although few studies to date have quantified transfusion-related iron burden in these patients. This study quantifies the transfused blood volume and resultant iron load in a large cohort of pediatric patients with ALL, and evaluates risk factors that may impact transfusion volume.

METHODS: This single institution retrospective study evaluated 107 patients who completed therapy for ALL between July 1995 and March 2007. Age, weight, and hemoglobin at presentation, ALL risk category, leukemia cell type, and volume of blood transfusions were collected from medical records.

RESULTS: Patients received an average of 115 ml/kg of blood (77 mg/kg iron) during treatment. There was a significant association between the volume of packed red blood cells and ALL risk category. Patients with standard-risk disease received 90 ml/kg (60 mg/kg iron), patients with high-risk disease 196 ml/kg (131 mg/kg iron) and patients with T-cell disease 114 ml/kg (76 mg/kg iron). There was no correlation between age or hemoglobin at presentation with amount of blood received.

CONCLUSIONS: Patients with ALL often receive a substantial amount of iron during therapy, with patients with high-risk disease receiving the greatest load. As iron overload has an overlapping toxicity profile with chemotherapy and is treatable, screening for increased iron burden and iron-related morbidities should be considered during long-term follow-up of patients with ALL, particularly in those with high-risk ALL.