Adverse impact of hyperferritinemia and transfusion dependency on treatment success in myelodysplastic syndrome

Çakar, Merih Kızıl; Yeğin, Zeynep Arzu; Baysal, Nuran Ahu; Altındal, Ş.; Pamukçuoğlu, Merve; Çelik, Bülent; Yenicesu, İdil

doi:10.1016/j.transci.2013.04.025

Cited by 6 publications

(13 citation statements)

References 29 publications

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“…The negative influence of iron overload on survival observed in our registry was in agreement with previous reports of Kikuchi et al [17], Takatoku et al [21] and Cakar et al [22]. Malcovati et al [10], Gattermann et al [19] and Garcia-Manero et al [23] also underlined a negative influence of transfusion-related iron overload on survival in MDS patients.…”

Section: Discussionsupporting

confidence: 93%

“…Hyperferritinemia was not associated with higher risk of transformation to AML. Taking into account the relatively low number of patients in previous studies exploring this topic (35-126 patients) [17,22,24] and underestimation of the prevalence and data regarding patients diagnosed with MDS in other registries [29] too, the presented study provides important insights.…”

Section: Discussionmentioning

confidence: 96%

“…Cakar et al [22] failed to confirm any impact of SF levels on overall survival, which might also be attributed to the small sample size and inadequate follow-up period.…”

Section: Discussionmentioning

confidence: 96%

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Red Blood Cell Transfusion Dependency and Hyperferritinemia Are Associated with Impaired Survival in Patients Diagnosed with Myelodysplastic Syndromes: Results from the First Polish MDS-PALG Registry

Waszczuk‐Gajda¹,

Mądry²,

Machowicz³

et al. 2016

Adv Clin Exp Med

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Background. Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal stem cell disorders characterized by ineffective hematopoiesis, cytopenias and a risk of progression to acute myeloid leukemia (AML). Anemia is the most frequent cytopenia diagnosed in patients with MDS. Regular RBC transfusions are the only treatment option for about 40% of patients. Transfusion-dependent patients develop secondary iron overload. The influence of serum ferritin (SF) concentration on survival and acute myeloid leukemia transformation in MDS patients remains controversial. The data for the Central European population is scarce and so far there is no description for Poland. Objectives. The aim of this study was to perform a retrospective analysis of the relationship of SF concentration with red blood cell transfusion dependency, survival and transformation to acute myeloid leukemia. Material and Methods. We retrospectively evaluated the data of the 819 MDS patients (58% male; median age 70 years) included in the MDS Registry of the MDS Section of the Polish Adult Leukemia Group (PALG). Results. Analyses were performed on 190 patients diagnosed with MDS, maximal 6 months before inclusion to the registry in order to avoid selection bias (a shorter survival of higher risk MDS patients). Patients with hyperferritinemia higher than 1000 ng/L vs. patients with SF concentration lower than 1000 ng/L had a median survival of 320 days vs. 568 days, respectively (p log-rank = 0.014). The following factors were found to significantly worsen survival: RBC-transfusion dependence (p = 0.0033; HR 2.67L), platelet transfusion dependence (p = 0.0071; HR 3.321), hemoglobin concentration lower than 10 g/dL (p = 0.0036; HR 2.97), SF concentration higher than 1000 ng/L (p = 0.0023; HR = 2.94), platelet count lower than 10 G/L (p = 0.0081 HR = 5.04), acute leukemia transformation (p = 0.0081; HR 1.968).

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 96%

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Red Blood Cell Transfusion Dependency and Hyperferritinemia Are Associated with Impaired Survival in Patients Diagnosed with Myelodysplastic Syndromes: Results from the First Polish MDS-PALG Registry

Waszczuk‐Gajda¹,

Mądry²,

Machowicz³

et al. 2016

Adv Clin Exp Med

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“…As for other hematological malignancies [7, 8], several studies have analyzed the role of SF as a prognostic factor in MDS patients reporting that higher SF level was associated with a reduction of both leukemia free survival (LFS) and overall survival (OS) [9,10]. Despite the large number of studies on MDS patients who have undergone hematopoietic stem cell transplantation (HSCT) [1, 11, 12], the prognostic impact of elevated SF levels is still controversial [13], above all in lower risk MDS patients [14].…”

Section: Introductionmentioning

confidence: 99%

Role of serum ferritin level on overall survival in patients with myelodysplastic syndromes: Results of a meta-analysis of observational studies

et al. 2017

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BackgroundThe role of serum ferritin (SF) as a prognostic factor has been analyzed in patients with myelodysplastic syndromes (MDS) who have undergone hematopoietic stem cell transplantation (HSCT), but the prognostic role of elevated SF levels is still controversial in lower risk MDS patients. Therefore, we performed a meta-analysis of all available published literature to evaluate whether elevated SF levels are associated with a worse overall survival (OS) among patients with low risk MDS.Material and methodsA systematic bibliographic search of relevant studies was undertaken in accordance with guidelines for meta-analysis of observational studies in epidemiology. Electronic databases were searched through July 2016 for studies examining the level of SF as a prognostic factor in the adults affected by MDS.ResultsSix articles were included in the meta-analysis. A significant association between OS and SF was achieved for the threshold of SF≥1000 ng/mL, when the only study that used SF cut-off ≥2000 ng/mL was not included in the meta-analysis (RR = 1.33; 95% CI = 1.06–1.67). The estimated risk was 2.58 (95% CI = 1.41–4.74) when a SF cut-off≥500 ng/mL was considered.ConclusionsOur findings underlined a worse survival in patients with MDS who had higher SF levels. The association was stronger and achieved statistical significance after stratification of analyses in which we excluded cut-offs of SF level considered as outliers. These results suggest that negative impact on OS already exist at SF level ≥500 ng/mL. Prospective studies, are needed to better understand this relationship and, above all, to clarify whether earlier iron chelation therapy could improve patients’ OS.

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“…Fourteen studies reported data on survival following diagnosis of MDS in relation to transfusion frequency, dependency and/or cumulative burden. 8,14,15,18,26,[29][30][31][40][41][42][43][44][45] The majority reported an inverse relationship between RBC transfusion and survival. Seven studies demonstrated poorer overall survival associated with transfusion dependency 8,14,15,18,26,31,41 and four reported that greater transfusion intensity was associated with decreased overall survival 29,30,42 and/or leukaemia-free survival.…”

Section: Survivalmentioning

confidence: 99%

Red blood cell transfusion in myelodysplastic syndromes: A systematic review

Kaka

Jahangirnia

Beauregard

et al. 2021

Transfusion Medicine

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Patients with myelodysplastic syndrome (MDS) frequently receive red blood cell (RBC) transfusions for anaemia resulting from ineffective erythropoiesis. While RBC transfusions may rapidly increase haemoglobin values, their impact on clinical and health services outcomes in MDS patients has not previously been summarized. We conducted a systematic review of the literature to evaluate risks and benefits of RBC transfusions in MDS patients. We searched electronic databases (MEDLINE, Embase, CENTRAL, CINAHL) from inception through June 4, 2021 to identify studies reporting data on RBC transfusions in MDS patients. Full text publications that assessed RBC transfusions as an intervention and reported at least one clinical, laboratory, or healthcare outcome associated with transfusion were included. Study characteristics, transfusion information and transfusion-related outcomes were extracted and reported. We identified 1243 original studies, of which 38 met eligibility requirements and were included.Fourteen reported on survival following diagnosis of MDS, with the majority reporting poorer survival among patients receiving or requiring more frequent transfusions. Nine reported on transfusion-related iron overload and its complications. Other outcomes included rates of allo/autoimmunization and adverse transfusion reactions, and healthcare costs incurred by patients with a greater transfusion burden. Only two studies reported on symptom relief following transfusion. This review underscores transfusion dependence as a negative prognostic factor for MDS patients and highlights the paucity of evidence surrounding quality of life and symptom-related outcomes following RBC transfusions in this population. Further study of patient-important outcomes associated with transfusion in MDS patients is warranted to improve therapeutic recommendations and inform resource allocation.

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Adverse impact of hyperferritinemia and transfusion dependency on treatment success in myelodysplastic syndrome

Cited by 6 publications

References 29 publications

Red Blood Cell Transfusion Dependency and Hyperferritinemia Are Associated with Impaired Survival in Patients Diagnosed with Myelodysplastic Syndromes: Results from the First Polish MDS-PALG Registry

Red Blood Cell Transfusion Dependency and Hyperferritinemia Are Associated with Impaired Survival in Patients Diagnosed with Myelodysplastic Syndromes: Results from the First Polish MDS-PALG Registry

Role of serum ferritin level on overall survival in patients with myelodysplastic syndromes: Results of a meta-analysis of observational studies

Red blood cell transfusion in myelodysplastic syndromes: A systematic review

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