Successful hemochromatosis following allogeneic stem cell transplantation for acute lymphoblastic leukemia

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A 41 ―year-old Japanese man with Philadelphia chromosome-positive acute lymphoblastic leukemia received allogeneic hematopoietic stem cell transplantation (allo-HSCT) from a human leukocyte antigen (HLA)-matched unrelated donor at molecular complete remission. Although bone marrow engraftment was successful, he required frequent red blood cell transfusions due to pure red cell aplasia following transplantation. He developed a high ferritinemia (4960 ng/ml) and secondary hemochromatosis and was treated with deferasirox for iron overload following allo-HSCT. After 10 months of iron chelation therapy, the serum ferritin level decreased to 575 ng/ml, serum aminotransferases returned to normal values, and magnetic resonance imaging revealed improvements in abnormal findings in the liver. Liver dysfunction after allo-HSCT was initially considered to be chronic graft-versus-host disease but actually occurred due to hepatic hemochromatosis. These results suggested that iron-chelating therapy with deferasirox is useful for patients presenting with iron overload following allo-HSCT.