Elevated Ferritin Prior to Collection and Mobilization May Predict Low Stem Cell Yield

Background Bone marrow transplantation requires collecting an adequate number of hematopoietic stem cells to ensure successful engraftment. Ferritin, a key iron storage protein and acute phase reactant, is routinely evaluated during pre-collection visits to assess for iron deficiency or overload and may impact stem cell capture. Physicians must anticipate difficulties in stem cell capture, and pre-collection ferritin levels may be helpful. Methods We conducted a retrospective chart review of 413 patients undergoing autologous transplantation at our center from 2016-2023. Patients (n=17) missing ferritin levels at pre-collection or stem cell capture data in the electronic medical record (EMR) were excluded from the analysis. Patient demographics, serum lab values at the pre-collection evaluation visit, total stem cell capture (TC), stem cell capture on the first day of apheresis (FC), and the total number of days of apheresis (DOA) were retrieved from the EMR. Ferritin level (FL) was grouped as low having serum concentration less than or equal to 50 ng/ml, normal being between 50.1-500 ng/ml, and high having greater than 500 ng/ml. Results Subjects with elevated ferritin had lower hemoglobin levels (p < 0.001), but none of the other pre-collection lab values were significantly different from the other groups. However, the high ferritin group had significantly lower FC (p=0.009) and more DOA (p < 0.001) than the normal ferritin group. Those findings remained significant after covarying for race, sex, age, and hemoglobin concentration. Conclusion Our results suggest that ferritin levels above 500 ng/ml may require planning for more days for the stem cell collection. An updated analysis will be done to evaluate long-term outcomes.