Association between Transfusion-Related Iron Overload and Liver Fibrosis in Survivors of Pediatric Leukemia: A Cross-Sectional Study
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Purpose: Patients who receive frequent blood transfusions are at an elevated risk of developing hepatic fibrosis due to iron overload in the liver. In this study, we evaluated the effectiveness of transient elastography (TE) (FibroScan®) for assessing liver fibrosis in patients with pediatric cancer. Methods: We enrolled 106 consecutive cases of acute leukemia in individuals under 21 years of age. The participants were followed for 2 years. Based on their serum ferritin (SF) levels, the patients were divided into two groups: group 1 (SF≥300 ng/mL) and group 2 (SF<300 ng/mL). A liver FibroScan® was performed, and a p-value of less than 0.05 was considered statistically significant. Results: Among the various parameters in the liver function test (LFT), alkaline phosphatase was significantly higher in a subgroup of patients aged 5–8 years in group 2 compared to those in group 1. The indices of liver fibrosis determined by TE, including the FibroScan score, controlled attenuation parameter score, steatosis percentage, and meta-analysis of histological data in viral hepatitis score, as well as indirect serum markers of liver fibrosis such as the aminotransferase (AST)/alanine aminotransferase (ALT) ratio, Fibrosis 4 score, and AST to platelet ratio index, did not differ significantly between the two groups. The association between the TE results and LFT parameters was only significant for ALT. Conclusion: Transfusion-associated iron overload does not have a significant correlation with severe liver fibrosis. FibroScan® is not a sensitive tool for detecting early stages of fibrosis in survivors of pediatric leukemia.
Abstract
Purpose: Patients who receive frequent blood transfusions are at an elevated risk of developing hepatic fibrosis due to iron overload in the liver. In this study, we evaluated the effectiveness of transient elastography (TE) (FibroScan®) for assessing liver fibrosis in patients with pediatric cancer. Methods: We enrolled 106 consecutive cases of acute leukemia in individuals under 21 years of age. The participants were followed for 2 years. Based on their serum ferritin (SF) levels, the patients were divided into two groups: group 1 (SF≥300 ng/mL) and group 2 (SF<300 ng/mL). A liver FibroScan® was performed, and a p-value of less than 0.05 was considered statistically significant. Results: Among the various parameters in the liver function test (LFT), alkaline phosphatase was significantly higher in a subgroup of patients aged 5–8 years in group 2 compared to those in group 1. The indices of liver fibrosis determined by TE, including the FibroScan score, controlled attenuation parameter score, steatosis percentage, and meta-analysis of histological data in viral hepatitis score, as well as indirect serum markers of liver fibrosis such as the aminotransferase (AST)/alanine aminotransferase (ALT) ratio, Fibrosis 4 score, and AST to platelet ratio index, did not differ significantly between the two groups. The association between the TE results and LFT parameters was only significant for ALT. Conclusion: Transfusion-associated iron overload does not have a significant correlation with severe liver fibrosis. FibroScan® is not a sensitive tool for detecting early stages of fibrosis in survivors of pediatric leukemia.
참고문헌 (28)
- Kew MC, "Hepatic iron overload and hepatocellular carcinoma", Liver Cancer, 3, pp.31~40 (2014)
- Quinn CT, "MRI measurements of iron load in transfusion-dependent patients : implementation, challenges, and pitfalls", Pediatr Blood Cancer, 63, pp.773~780 (2016)
- Shander A, "Iron overload and toxicity : the hidden risk of multiple blood transfusions", Vox Sang, 97, pp.185~197 (2009)
- Gattermann N, "Overview of guidelines on iron chelation therapy in patients with myelodysplastic syndromes and transfusional iron overload", Int J Hematol, 88, pp.24~29 (2008)
- Hosseini E, "The impact of HLA-E polymorphisms in graft-versus-host disease following HLA-E matched allogeneic hematopoietic stem cell transplantation", Iran J Allergy Asthma Immunol, 11, pp.15~21 (2012)
- Lucidarme D, "Factors of accuracy of transient elastography(fibroscan)for the diagnosis of liver fibrosis in chronic hepatitis C", Hepatology, 49, pp.1083~1089 (2009)
- Chon YE, "Performance of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B : a meta-analysis", PLoS One, 7, pp.e44930~ (2012)
- Vergara S, "The use of transient elastometry for assessing liver fibrosis in patients with HIV and hepatitis C virus coinfection", Clin Infect Dis, 45, pp.969~974 (2007)
- de Lédinghen V, "Diagnosis of hepatic fibrosis and cirrhosis by transient elastography in HIV", hepatitis C virus-coinfected patients, 2006, pp.41, 175~179
- Corpechot C, "Assessment of biliary fibrosis by transient elastography in patients with PBC and PSC", Hepatology, 43, pp.1118~1124 (2006)
- Sini M, "Non-invasive assessment of hepatic fibrosis in a series of patients with Wilson’s Disease", Dig Liver Dis, 44, pp.487~491 (2012)
- Adhoute X, "Diagnosis of liver fibrosis using FibroScan and other noninvasive methods in patients with hemochromatosis : a prospective study", Gastroenterol Clin Biol, 32, pp.180~187 (2008)
- Nguyen-Khac E, "Assessment of asymptomatic liver fibrosis in alcoholic patients using fibroscan : prospective comparison with seven non-invasive laboratory tests", Aliment Pharmacol Ther, 28, pp.1188~1198 (2008)
- Wong VW, "Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease", Hepatology, 51, pp.454~462 (2010)
- Park MS, "Non-invasive prediction of development of hepatocellular carcinoma using transient elastography in patients with chronic liver disease", Expert Rev Gastroenterol Hepatol, 8, pp.501~511 (2014)
- Laharie D, "Diagnosis of liver fibrosis by transient elastography(FibroScan)and non-invasive methods in Crohn’s disease patients treated with methotrexate", Aliment Pharmacol Ther, 23, pp.1621~1628 (2006)
- Barbero-Villares A, "Evaluation of liver fibrosis by transient elastography(Fibroscan®)in patients with inflammatory bowel disease treated with methotrexate : a multicentric trial", Scand J Gastroenterol, 47, pp.575~579 (2012)
- Berends MA, "Biochemical and biophysical assessment of MTX-induced liver fibrosis in psoriasis patients : Fibrotest predicts the presence and Fibroscan predicts the absence of significant liver fibrosis", Liver Int, 27, pp.639~645 (2007)
- Szurowska E, "The role of MR imaging in detection of hepatic iron overload in patients with cirrhosis of different origins", BMC Gastroenterol, 10, pp.13~ (2010)
- Mirault T, "Non-invasive assessment of liver fibrosis by transient elastography in post transfusional iron overload", Eur J Haematol, 80, pp.337~340 (2008)
- Musallam KM, "Longitudinal changes in serum ferritin levels correlate with measures of hepatic stiffness in transfusion-independent patients with β-thalassemia intermedia", Blood Cells Mol Dis, 49, pp.136~139 (2012)
- Bohte AE, "Non-invasive evaluation of liver fibrosis : a comparison of ultrasound-based transient elastography and MR elastography in patients with viral hepatitis B and C", Eur Radiol, 24, pp.638~648 (2014)
- Voskaridou E, "Liver transient elastography(FibroScan)correlates with liver iron concentration and reflects liver fibrosis in patients with sickle cell disease", Blood, 116, pp.1646~ (2010)
- Drasar E, "Interim assessment of liver damage in patients with sickle cell disease using new non-invasive techniques", Br J Haematol, 176, pp.643~650 (2017)
- Wang M, "Iron overload correlates with serum liver fibrotic markers and liver dysfunction : potential new methods to predict iron overload-related liver fibrosis in thalassemia patients", United European Gastroenterol J, 5, pp.94~103 (2017)
- Fraquelli M, "Transient elastography in the assessment of liver fibrosis in adult thalassemia patients", Am J Hematol, 85, pp.564~568 (2010)
- Ou G, "Utility of transient elastography in estimating hepatic iron concentration in comparison to magnetic resonance imaging in patients who are transfusion-dependent : a Canadian center experience", Hemoglobin, 41, pp.21~25 (2017)
- Wood JC, "MRI R2 and R2* mapping accurately estimates hepatic iron concentration in transfusion-dependent thalassemia and sickle cell disease patients", Blood, 106, pp.1460~1465 (2005)