Transfusion-Related Iron Overload in Children With Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma: Addressing an Overlooked Treatment Complication

We have demonstrated a high occurrence but an unsatisfactory approach to TRIO. A fair number of patients lacked SF measurements during the treatment and FU. Despite a considerable proportion of patients at risk of TRIO in our cohort, only four underwent MRI for tissue iron quantification. Unlike the ferritin assay, MRI is neither accessible nor cheap, and the need for sedation/anesthesia in young children probably leads to underutilization of the method. Furthermore, there was no consensus on genotyping for hereditary hemochromatosis. Older age and HR disease posed a greater risk for TRIO. Transfusion burden significantly impacted ferritin levels. We advise clinicians to follow a restrictive transfusion strategy and track the number of red blood cell units administered throughout the treatment to identify patients with especially worrisome iron influx. There is a strong need for the development of TRIO treatment guidelines for patients and survivors of childhood cancer.