Elevated Ferritin Is Associated with Relapse after Autologous Hematopoietic Stem Cell Transplantation for Lymphoma

Elevated serum ferritin is associated with reduced survival following allogeneic transplantation and an increased risk of toxic and infectious complications after autologous hematopoietic stem cell transplantation (ASCT). We studied 315 patients who underwent ASCT for Hodgkin (HL) or non-Hodgkin lymphoma (NHL) at our institution in whom pretransplantation ferritin was available to determine its association with survival. On multivariate analysis, a pretransplantation ferritin >685 ng/mL was associated with significantly lower overall (OS; P = .002) and relapse-free survival (RFS; P = .021). Ferritin >685 ng/mL was associated with a higher incidence of relapse (P = .005) and relapse mortality (P < .001), but not of nonrelapse mortality (NRM; P = .23). Similar results were seen when pretransplantation ferritin was analyzed as a continuous variable and by quartiles. Our results indicate the need for studies designed to correlate an elevated ferritin with iron overload and to analyze the benefit of strategies to reduce the extent of iron overload.