How I manage iron overload in the hemopoietic cell transplantation setting

The success of hematopoietic transplant for hemoglobinopathies and hematological malignancies has been accompanied by the new challenge of how to identify, risk stratify and treat iron overload/toxicity pre- and post-transplantation. Substantial progress has been made in our understanding of iron metabolism and pathophysiology of iron overload, making us aware that not only the total amount of iron in the body is important but also the effect of toxic iron species and duration of exposure are equally relevant. Challenges still remain in how to assess cellular and tissue damage and define the mechanism which may detrimentally affect the outcome of hematopoietic transplantation. In this article I discuss the impact of iron toxicity in relation to the different phases of hematopoietic transplantation, before, during and after, for both malignant and non-malignant diseases. Different clinical scenarios and possibilities for therapeutic intervention are also outlined and discussed.