Contributions
Abstract: PB2107
Type: Publication Only
Background
Iron overload due to an ineffective erythropoiesis and/or red cell transfusion is often observed in myelodysplastic syndrome (MDS) patients, resulting in damage of target organs including heart, liver, and pancreas. Several reports showed clinical impacts of iron overload in MDS.
Aims
In the present study, we retrospectively analyzed relationship between serum ferritin level at diagnosis and clinical features in MDS patients to evaluate clinical implication of serum ferritin level.
Methods
This retrospective observational study was conducted according to the Declaration of Helsinki, and approved by institutional ethics committee (No. 4301). We reviewed medical records and laboratory data base of the patients who were diagnosed as MDS between January 2003 and December 2016. Patients in whom serum ferritin level at the time of MDS diagnosis were available, were included this study. Patients with therapy-related MDS, with history of transfusion, any specific therapy for MDS were excluded from the study.
Results
A total of 98 patients (59 males and 39females, median age, 71 years, range, 20-91 years) were included into this study. Median follow-up period was 22.5 months (mean 39.0, range 0.4-165.7 months). We analyzed relationship between serum ferritin level and clinical parameters and laboratory data to evaluate clinical implication of serum ferritin level. Inverse correlation was observed between serum ferritin level and hemoglobin concentration (r=-0.4022, P<0.0001). Positive correlation was observed between serum ferritin level and ring-sideroblast percentage in bone marrow (r=0.4163, P=0.0002). No significant difference in serum ferritin level was observed among MDS subtypes, IPSS and IPSS-R risk categories. The Cox proportional hazards model was employed to evaluate prognostic significance of serum ferritin level, demonstrating that high serum ferritin level (more than 500 ng/ml) was associated with worse OS (hazard ratio=3.04, 95% CI, 1.58-5.70, P=0.0012). Patients were classified into two groups according to serum ferritin level, high (500 ng/ml or more) (‘H’), and low (less than 500 ng/ml) (‘L’) groups. Kaplan-Meier plots indicated that ‘H’ group showed shorter OS than ‘L’ group (log-rank test, P=0.0014). Estimated OS rates at 2 years, 5 years, and 10 years from diagnosis were 48.8%, 42.1%, and 12.0% in ‘H’ group, and 82.4%, 66.5%, and 50.4% in ‘L’ group, respectively. Subgroup analysis demonstrated that prognostic significance of serum ferritin level was obviously observed in patients with lower IPSS (Low and Int-1), but not in those with higher IPSS (High and Int-2). Among patients with lower IPSS, Kaplan-Meier plots demonstrated significant worse OS in ‘H’ group compared with ‘L’ group (log-rank test, P=0.0003); estimated 2-year, 5-year and 10-year OS rates were 44.0%, 30.8%, and 0% in ‘H’ group, and 73.2%, 62.5%, and 47.1% in ‘L’ group, respectively. In contrast, among patients with higher IPSS, no difference in OS was observed between ‘H’ and ‘L’ groups (log-rank test, P=0.9224).
Conclusion
Our present results showed correlation between serum ferritin level at diagnosis and degree of anemia, suggesting serum ferritin level reflects dyserythropoiesis. High serum ferritin level at diagnosis was associated with worse survival in low risk MDS patients, indicating clinical implication of serum ferritin level as a prognostic marker.
Session topic: 10. Myelodysplastic syndromes – Clinical
Keyword(s): Ferritin, Myelodysplasia
Abstract: PB2107
Type: Publication Only
Background
Iron overload due to an ineffective erythropoiesis and/or red cell transfusion is often observed in myelodysplastic syndrome (MDS) patients, resulting in damage of target organs including heart, liver, and pancreas. Several reports showed clinical impacts of iron overload in MDS.
Aims
In the present study, we retrospectively analyzed relationship between serum ferritin level at diagnosis and clinical features in MDS patients to evaluate clinical implication of serum ferritin level.
Methods
This retrospective observational study was conducted according to the Declaration of Helsinki, and approved by institutional ethics committee (No. 4301). We reviewed medical records and laboratory data base of the patients who were diagnosed as MDS between January 2003 and December 2016. Patients in whom serum ferritin level at the time of MDS diagnosis were available, were included this study. Patients with therapy-related MDS, with history of transfusion, any specific therapy for MDS were excluded from the study.
Results
A total of 98 patients (59 males and 39females, median age, 71 years, range, 20-91 years) were included into this study. Median follow-up period was 22.5 months (mean 39.0, range 0.4-165.7 months). We analyzed relationship between serum ferritin level and clinical parameters and laboratory data to evaluate clinical implication of serum ferritin level. Inverse correlation was observed between serum ferritin level and hemoglobin concentration (r=-0.4022, P<0.0001). Positive correlation was observed between serum ferritin level and ring-sideroblast percentage in bone marrow (r=0.4163, P=0.0002). No significant difference in serum ferritin level was observed among MDS subtypes, IPSS and IPSS-R risk categories. The Cox proportional hazards model was employed to evaluate prognostic significance of serum ferritin level, demonstrating that high serum ferritin level (more than 500 ng/ml) was associated with worse OS (hazard ratio=3.04, 95% CI, 1.58-5.70, P=0.0012). Patients were classified into two groups according to serum ferritin level, high (500 ng/ml or more) (‘H’), and low (less than 500 ng/ml) (‘L’) groups. Kaplan-Meier plots indicated that ‘H’ group showed shorter OS than ‘L’ group (log-rank test, P=0.0014). Estimated OS rates at 2 years, 5 years, and 10 years from diagnosis were 48.8%, 42.1%, and 12.0% in ‘H’ group, and 82.4%, 66.5%, and 50.4% in ‘L’ group, respectively. Subgroup analysis demonstrated that prognostic significance of serum ferritin level was obviously observed in patients with lower IPSS (Low and Int-1), but not in those with higher IPSS (High and Int-2). Among patients with lower IPSS, Kaplan-Meier plots demonstrated significant worse OS in ‘H’ group compared with ‘L’ group (log-rank test, P=0.0003); estimated 2-year, 5-year and 10-year OS rates were 44.0%, 30.8%, and 0% in ‘H’ group, and 73.2%, 62.5%, and 47.1% in ‘L’ group, respectively. In contrast, among patients with higher IPSS, no difference in OS was observed between ‘H’ and ‘L’ groups (log-rank test, P=0.9224).
Conclusion
Our present results showed correlation between serum ferritin level at diagnosis and degree of anemia, suggesting serum ferritin level reflects dyserythropoiesis. High serum ferritin level at diagnosis was associated with worse survival in low risk MDS patients, indicating clinical implication of serum ferritin level as a prognostic marker.
Session topic: 10. Myelodysplastic syndromes – Clinical
Keyword(s): Ferritin, Myelodysplasia