January 1999, Volume 23, Issue 1, Pages 95 – 97

Case Report

Iron depletion by phlebotomy with recombinant erythropoietin prior to allogeneic transplantation to prevent liver toxicity J de la Serna1, R Bornstein, M-J García-Bueno & J-J Lahuerta-Palacios Servicio de Hematología, Hospital Universitario 12 de Octubre, Madrid, Spain     1Correspondence: Dr J de la Serna Torroba, Servicio de Hematología, Hospital Universitario 12 de Octubre, Avenida de Andalucía 5400, 28041 Madrid, Spain

Keywords

iron toxicity;   phlebotomy;   erythropoietin;   hepatitis

Abstract

Iron overload may induce liver toxicity after hematopoietic stem cell transplantation (HSCT), but it is not known if iron depletion prior to HSCT can reduce the risk of severe toxicity in this setting. We used subcutaneous recombinant erythropoietin (EPO) (25 UI/kg) three times a week and phlebotomy once a week, to prevent liver toxicity in a patient with advanced acute leukemia and liver disease due to severe iron overload, previous drug toxicity and hepatitis C viral infection. Over the 9 months prior to allogeneic HSCT, 34 phlebotomies were carried out. Serum ferritin dropped from 2964 to 239 µg/l and the ALT dropped to near normal values. At allogeneic HSCT no liver toxicity was observed, suggesting that iron depletion in the pretransplant period may contribute to reducing transplant-related toxicity in selected cases.

Received 11 May 1998; Accepted 19 August 1998

^© Macmillan Publishers Ltd 1997