Non transferrin bound iron (NTBI) in acute leukemias throughout conventional intensive chemotherapy: Kinetics of its appearance and potential predictive role in infectious complications
Non transferrin bound iron (NTBI) in acute leukemias throughout conventional intensive chemotherapy: Kinetics of its appearance and potential predictive role in infectious complications
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DOI：
10.1016/j.leukres.2014.11.003
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发表时间：
2015-01-01
影响因子：
2.7
通讯作者：
Cappellini, Maria Domenica
中科院分区：
文献类型：
--
作者：
Belotti, Angelo;Duca, Lorena;Cappellini, Maria Domenica
本文分析了30例急性髓系白血病（AML）和急性淋巴细胞白血病（ALL）移植患者常规化疗期间非转铁蛋白结合铁（NTBI）的出现情况，并评估了其与输血体铁摄入量、铁参数和临床并发症的可能关系。对于每个疗程，在化疗前、治疗期间和随后的骨髓抑制期间采集用于NTBI检测的血清样品：通过HPLC评估NTBI。从诱导治疗开始观察到NTBI的出现，并且在骨髓抑制期间仍然可以检测到;骨髓功能的恢复与NTBI的消失一致。这种动力学在所有后续的高剂量化疗过程中观察到，独立于混杂变量，如输血铁摄入量和转铁蛋白饱和度。NTBI似乎是化疗诱导的骨髓细胞溶解的结果，部分是细胞毒性损伤后肝细胞溶解的结果。NTBI随后在整个骨髓抑制中的持续性与红细胞生成活性的短暂暂停有关。此外，与其他感染并发症（RR 1.954）相比，医源性骨髓抑制开始时NTBI水平>2 μ M与由革兰氏阴性杆菌引起的脓毒症的较高风险相关（RR 2.571）。(C)2014爱思唯尔有限公司版权所有。
We analyzed appearance of non transferrin bound iron (NTBI) in 30 transplant eligible patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) during conventional chemotherapy treatment program and evaluated possible relationship with transfusional body iron intake, iron parameters and clinical complications. For each course, serum samples for NTBI detection were taken prior to chemotherapy, during treatment and during subsequent bone marrow myelosuppression: NTBI was assessed by HPLC. Appearance of NTBI was observed from the start of induction treatment and was still detectable during bone marrow myelosuppression; the recovery of the bone marrow function coincided with the disappearance of NTBI. This kinetic was observed in all subsequent high doses chemotherapy courses, independently from confounding variables such as transfusional iron intake and transferrin saturation. NTBI seems to be a consequence of chemotherapy induced lysis of bone marrow cells and, partly, of hepatocytes after cytotoxic injury. The subsequent persistence of NTBI throughout bone marrow myelosuppression is related to the transient suspension of erythropoietic activity. Moreover, NTBI levels >2 mu M at the beginning of iatrogenic myelosuppression were associated with higher risk of sepsis caused by Gram negative Bacilli (RR 2.571), also compared with other infectious complications (RR 1.954). (C) 2014 Elsevier Ltd. All rights reserved.