Rust and corrosion in hematopoietic stem cell transplantation: The problem of iron and oxidative stress

A. M. Evens, J. Mehta, L. I. Gordon*

*Corresponding author for this work

Research output: Contribution to journalShort surveypeer-review

93 Scopus citations


Iron overload is a common acute and long-term event associated with autologous and allogeneic hematopoietic stem cell transplantation (HSCT). In a state of iron excess, free iron becomes available to catalyze the conversion of reactive oxygen species (ROS) intermediates such as superoxide anion (O2•-) and hydrogen peroxide (H2O2) to highly toxic free radicals such as hydroxyl radical (OH). ROS may help to promote chronic liver disease, sinusoidal obstruction syndrome, idiopathic pneumonia syndrome and bacterial, fungal and other opportunistic infections. Phlebotomy has been effectively and safely used to deplete excess iron stores post-HSCT in thalassemic and other iron-overloaded patients. Intracellular iron levels may also be decreased through pharmacologic chelating agents, while antioxidants such as N-acetylcysteine, glutamine (glutathione precursor) and captopril have been shown to replenish glutathione redox potential and scavenge free radicals. A better understanding of the mechanisms involved in the iron-generated pro-oxidant state associated with HSCT will likely lead to reduced toxicity and improved patient outcomes.

Original languageEnglish (US)
Pages (from-to)561-571
Number of pages11
JournalBone Marrow Transplantation
Issue number7
StatePublished - Oct 2004


  • Free radicals
  • Hematopoietic stem cell transplantation
  • Idiopathic pneumonia syndrome
  • Iron
  • Reactive oxygen species
  • Sinusoidal obstruction syndrome

ASJC Scopus subject areas

  • Transplantation
  • Hematology


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