Diagnosis of adverse events following
hematopoietic stem cell transplantation (HSCT) is mainly assigned to clinical symptoms or biopsies and thus rather unspecific and/or invasive. Studies indicate a distinct role of serum
ferritin in HSCT and its correlation with adverse events such as
graft-versus-host disease (GvHD), veno-occlusive disease (VOD), or
infections. However, published data on the relevance of
ferritin as a prognostic marker for post-transplant adverse events is rare, especially in pediatric patients. The present study analyzes
ferritin plasma concentrations of 138 pediatric patients after HSCT between 2007 and 2010 including the control group (n = 21). Given the initial results regarding
ferritin as a significant predictor for acute graft rejection after allogeneic HSCT in 9 of the 138 pediatric patients, serum
ferritin of all pediatric patients (n = 27) who experienced graft rejection between 2007 and 2014 was analyzed. In addition, laboratory parameters including
C-reactive protein (CRP),
lactate dehydrogenase (LDH),
fibrinogen, and
D-dimer as possible
differentiation markers for graft rejection were determined. In 24 (88.9 %) of the 27 pediatric patients with graft rejection, a significant increase of
ferritin levels was observed 1 to 7 days prior to (P < 0.0001) and at the time of graft rejection (P < 0.0001). Moreover, there was an increase of
D-dimer, CRP, LDH, and
fibrinogen 1-7 days before graft rejection.
Ferritin increased significantly at time of VOD (P = 0.0067), at time of intestinal (P < 0.0001) and skin GvHD (P < 0.0001), and at time of
sepsis (P = 0.0005) and
bacteremia (P = 0.0029).
Ferritin might serve as a readily available identification marker for differentiation and identification of adverse events after HSCT in combination with other
laboratory markers.