Frequent severe liver iron overload after stem cell transplantation and its possible association with invasive aspergillosis

Iron overload is associated with free radical generation and tissue damage. Our main objective was to ascertain the frequency and severity of iron overload in a group of 59 patients who died after conventional-intensity autologous (n = 24) or allogeneic ( n = 35) haematopoietic stem cell transplantation (HSCT). A second objective was to investigate associations between liver-iron concentration and causes of transplant-related mortality. The median age was 41 years ( range, 19 - 66), 41 were males and 18 females. In total, 26 patients had acute leukaemia or MDS, 10 CML, 17 lymphoma, four myeloma and two aplastic anaemia. The median hepatic iron concentration (HIC) was 138 mumol/g dry weight (7.7 mg/g; range 31 +/- 631 mumol/g). In total, 4/32 (12%) patients with HIC <150 μmol/g and 10/27 (37%) with hepatic iron ≥150 μmol/g showed invasive aspergillosis at autopsy ( P = 0.035). This was significant in multivariate analysis (RR 9.0; 95% CI 1.6 - 50.3, P = 0.012). In conclusion, severe iron overload is frequent in patients who die following HSCT and is associated with invasive aspergillosis.