Work

MRI-detected hepatic and cardiac iron overload despite ferritin-guided chelation in thalassemia: A predictive modelling study

Year: 2026

Type: article

Abstract: Background Serum ferritin used widely, is often unable reflect organ-specific iron burden in thalassemia. We evaluated the adequacy of ferritin-guided chelation in predicting iron overload and examined determinants of ferritin–MRI discordance. Methods 65 children and young adults with thalassemia undergoing MRI T2* assessment were included. Serial ferritin measurements over prior 6–12 months were used to derive mean ferritin and variability. Primary outcomes were myocardial iron overload (cardiac T2* <20 ms) and moderate-to-severe hepatic iron overload. Predictors spanning iron exposure, disease biology, and ferritin dynamics were analysed using Firth penalized logistic regression, with model performance assessed by bootstrap-corrected AUC. Results Hepatic iron overload was present in 77% and myocardial iron overload in 22% of patients despite ferritin-guided chelation. Ferritin showed moderate correlation with cardiac T2* (r = −0.51) and weaker correlation with hepatic T2* (r = −0.40), with substantial inter-individual variability. In multivariable analysis, age, transfusion-dependent status, and ferritin variability were independently associated with myocardial iron overload, whereas mean ferritin was not. Model discrimination was good (AUC 0.83). Ferritin–MRI discordance was observed in 38% of patients. Conclusion Ferritin-guided chelation does not reliably predict organ-specific iron burden. Incorporating MRI is essential for accurate detection of clinically significant iron overload.

Source: Pediatric Hematology Oncology Journal

DOI: 10.1016/j.phoj.2026.101178