A Systematic Literature Review of the Relationship between Serum Ferritin and Outcomes in Myelodysplastic Syndromes

Abstract

Anemia is the most common form of cytopenia in patients with myelodysplastic syndromes (MDS), who require chronic red blood cell transfusions and may present high serum ferritin (SF) levels as a result of iron overload. To better understand the potential effects of high SF levels, we conducted a systematic literature review (SLR) to identify evidence on the relationship between SF levels and clinical, economic, or humanistic outcomes in adult patients with MDS. Of 267 references identified, 21 were included. No studies assessing SF levels and their relationship with humanistic or economic outcomes were identified. Increased SF levels were an indicator of worse overall survival and other worsened outcomes; however, the association was not consistently significant. SF levels were a significant prognostic factor for relapse incidence of MDS and showed a significant positive correlation with number of blood units transfused but were not associated with progression to acute myeloid leukemia or the time to transformation. Higher SF levels were also an indicator of a lower likelihood of leukemia-free survival, relapse-free survival, and event-free survival. The SLR suggests that SF levels are associated with clinical outcomes in MDS, with higher levels correlated with number of blood units transfused, frequently indicating worse outcomes.

Myelodysplastic Syndromes and Myelodysplastic Syndromes/Myeloproliferative Neoplasms: A Real-World Experience From a Developing Country

“…Its incorporation into risk stratification could help identify high-risk patients most likely to benefit from alternative therapeutic approaches. 48 , 49 …”

Ferric Carboxymaltose and Erythropoiesis-Stimulating Agent Treatment Reduces the Rate of Blood Transfusion in Refractory Anemia

“…However, iron levels were not associated with progression to acute myeloid leukemia or with the time to transformation [ 18 ]. Higher iron levels were also an indicator of a lower likelihood of leukemia-free survival, relapse-free survival, and event-free survival [ 18 ]. Safety of parenteral iron is a historical concern that is based on experience from obsolete high molecular weight iron dextran formulations [ 19 ].…”

“…In addition, iron levels have been considered for a long time a significant prognostic marker for relapse incidence of MDS and showed a significant positive correlation with the number of RBCTs. However, iron levels were not associated with progression to acute myeloid leukemia or with the time to transformation [ 18 ]. Higher iron levels were also an indicator of a lower likelihood of leukemia-free survival, relapse-free survival, and event-free survival [ 18 ].…”

Role of Iron and Iron Overload in the Pathogenesis of Invasive Fungal Infections in Patients with Hematological Malignancies

“…Although the diagnosis of iron overload can be confirmed by various invasive and non-invasive (imaging) methods, the simplest, most widely used, but not the most accurate method is to determine serum ferritin values; a serum ferritin value of 1000 µg/L or more is mainly used in hematology as a cut off value, which indicates treatment with iron chelators [ 17 , 18 ]. In their meta-analysis, Oliva and colleagues suggested that a higher concentration of serum ferritin is a prognostic indicator of shorter survival in patients with myelodysplastic syndrome, as shown by some earlier research [ 19 , 20 ]. Although some data suggest that non-transferrin-bound iron and labile plasma iron could have a proleukemic effect achieved through reactive oxygen species (ROS) [ 21 , 22 ], the two papers included in this meta-analysis did not establish a possible relationship between serum ferritin level and progression to AML [ 23 , 24 ].…”