Burden beyond the cure: Iron overload following pediatric stem cell transplantation

Abstract

Iron overload (IOL) is an increasingly recognized complication among pediatric and young adult survivors of hematopoietic stem cell transplantation (HSCT) contributing to significant morbidity and mortality. The pathogenesis of IOL post-HSCT is multifactorial, driven by transfusion burden, impaired erythropoiesis, and increased gastrointestinal iron absorption, leading to toxic non-transferrin bound iron accumulation and oxidative tissue injury. Despite its clinical significance, consensus guidelines for the diagnosis, monitoring, and management of IOL in this population remain limited. This review examines the physiology and pathophysiology of iron metabolism, the clinical impact of post-HSCT IOL, whilst discussing evidence-based strategies for prevention and treatment. Particular attention is given to the unique challenges of managing iron overload in children, adolescents, and young adults, where individualized treatment and careful surveillance are critical.