E-ISSN: 1308-5263
Evaluation of Liver Iron Content by Magnetic Resonance Imaging in Children with Acute Lymphoblastic Leukemia after Cessation of Treatment [Turk J Hematol]
Turk J Hematol. 2020; 37(4): 263-270 | DOI: 10.4274/tjh.galenos.2020.2019.0364  

Evaluation of Liver Iron Content by Magnetic Resonance Imaging in Children with Acute Lymphoblastic Leukemia after Cessation of Treatment

Sezer Acar1, Salih Gözmen2, Selen Bayraktaroğlu3, Sultan Okur Acar2, Neryal Tahta2, Yeşim Aydınok4, Raziye C. Vergin2
1Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatrics, İzmir, Turkey
2Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Division of Pediatric Hematology and Oncology, İzmir, Turkey
3Ege University Faculty of Medicine, Department of Radiology, İzmir, Turkey
4Ege University Faculty of Medicine, Division of Pediatric Hematology and Oncology, İzmir, Turkey

Objective: There are a limited number of studies evaluating iron overload in childhood leukemia by magnetic resonance imaging (MRI). The aim of this study was to determine liver iron content (LIC) by MRI in children with acute lymphoblastic leukemia (ALL) who had completed treatment and to compare those values with serum iron parameters.
Materials and Methods: A total of 30 patients between the ages of 7 and 18 who had completed ALL treatment were included in the study. Serum iron parameters (serum iron, serum ferritin [SF], and total ironbinding capacity) and liver function tests were studied. R2 MRI was performed for determining LIC.
Results: Normal LIC was detected in 22 (63.4%) of the cases. Seven (23.3%) had mild and 1 (3.3%) had moderate liver iron deposition. In contrast, severe iron overload was not detected in any of the cases. LIC levels were correlated with the numbers of packed red blood cell (pRBC) transfusions (r=0.637, p<0.001), pRBC transfusion volume (r=0.449, p<0.013), SF levels (r=0.561, p=0.001), and transferrin saturation (r=0.353, p=0.044). In addition, a positive correlation was found between the number of pRBC transfusions and SF levels (r=0.595, p<0.001).
Conclusion: We showed that the frequency of liver iron deposition was low and clinically less significant after the end of treatment in childhood ALL patients. LIC was demonstrated to be related to SF and transfusion history. These findings support that SF and transfusion history may be used as references for monitoring iron accumulation or identifying cases for further examinations such as MRI.

Keywords: Acute lymphoblastic leukemia, Iron overload, Complications, Pediatric leukemia


Tedavisi Tamamlanmış Akut Lenfoblastik Lösemili Çocuklarda Manyetik Rezonans Görüntüleme ile Karaciğer Demir İçeriğinin Değerlendirilmesi

Sezer Acar1, Salih Gözmen2, Selen Bayraktaroğlu3, Sultan Okur Acar2, Neryal Tahta2, Yeşim Aydınok4, Raziye C. Vergin2
1Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatrics, İzmir, Turkey
2Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Division of Pediatric Hematology and Oncology, İzmir, Turkey
3Ege University Faculty of Medicine, Department of Radiology, İzmir, Turkey
4Ege University Faculty of Medicine, Division of Pediatric Hematology and Oncology, İzmir, Turkey

Amaç: Çocukluk çağı lösemisinde aşırı demir yükünü manyetik rezonans görüntüleme (MRG) ile değerlendiren sınırlı sayıda çalışma vardır. Bu çalışmanın amacı, akut lenfoblastik lösemisi (ALL) olan ve tedavisini tamamlamış olan çocuklarda R2 MRI yöntemiyle karaciğer demir içeriğini (LIC) belirlemek ve serum demir parametreleriyle karşılaştırmaktır.
Gereç ve Yöntem: Çalışmaya ALL tedavisini tamamlayan 7-18 yaşları arasında toplam 30 hasta alındı. Serum demir parametreleri (serum demir, serum ferritin [SF] ve toplam demir bağlama kapasitesi), karaciğer fonksiyon testleri çalışıldı. LIC’yi belirlemek için R2 MRG yöntemi kullanıldı.
Bulgular: Olguların 22’sinde (%63,4) normal LIC saptandı. Yedi (%23,3) olguda hafif ve 1 (%3,3) olguda orta derecede karaciğerde demir birikimi mevcuttu. Buna karşılık, hiçbir olguda ciddi derecede demir birikimi tespit edilmedi. LIC seviyeleri, pRBC transfüzyonu sayısı (r=0,637, p<0,001), pRBC transfüzyon miktarı (r=0,449, p<0,013), SF seviyeleri (r=0,561, p=0,001) ve transferrin (r=0,353, p=0,044) ile korele saptandı. Ek olarak, pRBC transfüzyonlarının sayısı ile SF seviyeleri arasında pozitif korelasyon bulundu (r=0,595, p<0,001).
Sonuç: Çocukluk çağı ALL hastalarında tedavi bitiminden sonra karaciğer demir birikiminin sıklığının düşük ve klinik olarak daha az önemli olduğunu gösterdik. Ayrıca, LIC’nin SF ve transfüzyon öyküsü ile ilişkili olduğunu gösterdik. Bu bulgular, SF ve transfüzyon geçmişinin demir birikimini izlemek veya MRG gibi ileri tetkikin gerekli olduğu olguları belirlemek açısından referans olarak kullanılabileceğini desteklemektedir.

Anahtar Kelimeler: Akut lenfoblastik lösemi, Demir birikimi, Komplikasyonlar, Pediatrik lösemi


Sezer Acar, Salih Gözmen, Selen Bayraktaroğlu, Sultan Okur Acar, Neryal Tahta, Yeşim Aydınok, Raziye C. Vergin. Evaluation of Liver Iron Content by Magnetic Resonance Imaging in Children with Acute Lymphoblastic Leukemia after Cessation of Treatment. Turk J Hematol. 2020; 37(4): 263-270

Corresponding Author: Sezer Acar


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