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PEDIATRICS Vol. 111 No. 1 January 2003, pp. 91-96

Iron Overload in Children Who Are Treated for Acute Lymphoblastic Leukemia Estimated by Liver Siderosis and Serum Iron Parameters

Päivi Halonen, MD*,{ddagger}, Jorma Mattila, MD PhD§, Pauli Suominen, MD, PhD||, Tarja Ruuska, MD, PhD{ddagger}, Matti K. Salo, MD, PhD{ddagger} and Anne Mäkipernaa, MD, PhD

* Paediatric Research Centre, Medical School, University of Tampere, Tampere, Finland
{ddagger} Departments of Pediatrics
§ Pathology, Tampere University Hospital, Tampere, Finland
|| Turku University Central Hospital Laboratories Unit, Turku University Central Hospital, Turku, Finland
Finnish Red Cross Blood Transfusion Service, Helsinki, Finland

--> Objective. To evaluate a secondary liver iron overload and its fate in children who are treated conventionally for acute lymphoblastic leukemia and to assess whether serum soluble transferrin receptor (sTfR) is useful in detecting iron load.

Methods. Liver siderosis was estimated histologically from liver biopsy specimens of 30 children (aged 2.6–17.6 years) close to or at the end of therapy using total iron score (TIS). Serum iron parameters and sTfR were measured at the same time and in 22 patients 1 to 3 years after therapy.

Results. In 19 (63%) of 30 patients, liver TIS was >15, indicating at least moderate iron overload. Serum ferritin, iron, and transferrin iron saturation levels were highest and transferrin level lowest in the patients with the highest liver iron content. Serum sTfR levels did not differ significantly between the patients with varying amounts of liver iron. TIS correlated most significantly positively with serum ferritin (rS = 0.899), transferrin iron saturation (rS = 0.764), and the amount of transfused red blood cells (rS = 0.783). Serum iron parameters normalized in most patients during the follow-up. In 3 (14%) of 22 patients, serum ferritin level remained high (>1000 µg/L).

Conclusions. Long-term iron overload is detected in at least 14% of children after therapy for acute lymphoblastic leukemia. Serum sTfR is an inappropriate marker for liver iron overload, whereas ferritin seems to be the most useful serologic marker for it.

Key Words: acute lymphoblastic leukemia • iron overload • liver siderosis

Abbreviations: ALL, acute lymphoblastic leukemia • RBC, red blood cell • sTfR, soluble transferrin receptor • IR, intermediate risk • HR, high risk • TIS, total iron score

Received for publication Feb 7, 2002; Accepted Jun 4, 2002.




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