Prognostic impact of elevated pretreatment serum ferritin in patients with high-risk MDS treated with azacitidine

Laribi, Kamel; Bolle, Delphine; Alani, Mustapha; Ghnaya, Habib; Bourdelles, Saga Le; Besançon, Anne; Farhi, Jonathan; Denizon, Nathalie; Materre, Alix Baugier de

doi:10.1016/j.exphem.2018.05.006

Cited by 8 publications

(5 citation statements)

References 19 publications

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“…Our results from this prospective study indicate that serum ferritin prior to alloSCT is associated to mortality after alloSCT. This trial served as confirmation of previous retrospective studies, which delivered preliminary results pointing in the same direction (7,(14)(15)(16)(17)(18). Of note, the Center for International Blood and Marrow Transplantation Research (CIBMTR) published an evaluation on different biomarkers and found that ferritin levels above 2500µg/ml were not associated with inferior alloSCT outcome (23) contrasting previously published studies (7,(14)(15)(16)(17)(18) and our results.…”

Section: Discussionsupporting

confidence: 86%

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Association of Serum Ferritin Levels Before Start of Conditioning With Mortality After alloSCT – A Prospective, Non-interventional Study of the EBMT Transplant Complications Working Party

et al. 2020

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Frontiers in Immunology | www.frontiersin.org April 2020 | Volume 11 | Article 586 Penack et al. Ferritin and alloSCT Outcomehigher infection-related mortality in the high ferritin group (HR = 3.9, CI = 1.6-9.7, p = 0.003). Acute and chronic GVHD incidence or severity were not associated to serum ferritin levels. We conclude that ferritin levels can serve as routine laboratory biomarker for mortality risk assessment before alloSCT.

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Section: Discussionsupporting

confidence: 86%

“…In all these clinical situations serum ferritin, an acute phase and iron binding protein, has been demonstrated to be elevated (6)(7)(8)(9)(10)(11)(12)(13). Based on this background results, several retrospective studies and metaanalyses have suggested that serum ferritin may be of use as a biomarker during alloSCT (7,(14)(15)(16)(17)(18).…”

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confidence: 97%

Association of Serum Ferritin Levels Before Start of Conditioning With Mortality After alloSCT – A Prospective, Non-interventional Study of the EBMT Transplant Complications Working Party

et al. 2020

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“…Secondary hemochromatosis may result in a higher risk of infections, multiple organ failure, and poor outcomes [12,40,41]. It has been confirmed that patients treated with AZA with higher SF levels achieve a significantly lower response rate and shorter survival [12,41]. The present study, based on univariate and multivariate analysis, revealed a negative prognostic value of higher SF level in terms of PFS.…”

Section: Discussionsupporting

confidence: 67%

“…Iron overload is often a clinical problem in transfusion-dependent patients, limiting the efficacy of MDS treatment. Secondary hemochromatosis may result in a higher risk of infections, multiple organ failure, and poor outcomes [12,40,41]. It has been confirmed that patients treated with AZA with higher SF levels achieve a significantly lower response rate and shorter survival [12,41].…”

Section: Discussionmentioning

confidence: 96%

Real-World Outcome and Prognostic Factors in MDS Patients Treated with Azacitidine—A Retrospective Analysis

Wiśniewski,

Pruszczyk-Matusiak,

Puła

et al. 2024

Cancers

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Azacitidine (AZA) is recognized as a vital drug used in the therapy of myelodysplastic syndromes (MDS) due to its beneficial effect on survival and quality of life. Nevertheless, many patients fail to respond to AZA treatment, as prognostic factors still are not identified. The present retrospective analysis included 79 patients with MDS treated with AZA as first-line therapy in a real-life setting. The percentage of patients with good, intermediate, and poor cytogenetics was 46.8%, 11.4%, and 34.2%, respectively. The overall response rate (complete remission [CR], partial remission [PR], and hematological improvement [HI]) was 24%. The CR, PR, and HI rates were 13.9%, 2.5%, and 7.6%, respectively. Stable disease (SD) was documented in 40.5% of patients. The median overall survival (OS) and progression-free survival (PFS) were 17.6 and 14.96 months, respectively. Patients with ORR and SD had a significantly longer median OS (23.8 vs. 5.7 months, p = 0.0005) and PFS (19.8 vs. 3.5 months, p < 0.001) compared to patients who did not respond to AZA. In univariate analysis, only an unfavorable cytogenetic group was a prognostic factor of a lower response rate (p = 0.03). In a multivariate model, older age (p = 0.047), higher IPSS (International Prognostic Scoring System) risk (p = 0.014), and higher IPSS-R cytogenetic risk (p = 0.004) were independent factors of shorter OS. Independent prognostic factors for shorter PFS were age (p = 0.001), IPSS risk (p = 0.02), IPSS cytogenetic risk (p = 0.002), and serum ferritin level (p = 0.008). The safety profile of AZA was predictable and consistent with previous studies. In conclusion, our study confirms the efficacy and safety of AZA in a real-world population and identifies potential biomarkers for response and survival.

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“…They found that patients with SF level < 725 ng/mL had significantly better OS (57% at 2 years) than those with SF level ⩾ 725 ng/mL (28% at 2 years). 23 Moreover, our group recently identified the adverse prognostic value of the high SF levels in patients with chronic myelomonocytic leukemia. 24 Of note, ferritin cutoff levels have been inconsistent throughout these studies.…”

Section: Discussionmentioning

confidence: 99%

Serum ferritin and ECOG performance status predict the response and improve the prognostic value of IPSS or IPSS-R in patients with high-risk myelodysplastic syndromes and oligoblastic acute myeloid leukemia treated with 5-azacytidine: a retrospective analysis of the Hellenic national registry of myelodysplastic and hypoplastic syndromes

Papageorgiou

Kotsianidis

Symeonidis

et al. 2020

Therapeutic Advances in Hematology

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Background: 5-azacytidine (5-AZA) improves survival of patients with higher-risk myelodysplastic syndromes (MDSs) and oligoblastic acute myeloid leukemia (AML); however, predictive factors for response and outcome have not been consistently studied. Methods: This study of the Hellenic MDS Study Group included 687 consecutive patients with higher-risk MDS and oligoblastic AML treated with 5-AZA. Results: The International Prognostic Scoring System (IPSS) revised version (IPSS-R), Eastern Cooperative Oncology Group Performance Status (ECOG PS) (0 or 1 versus ⩾2) and baseline serum ferritin (SF) levels > 520 ng/ml were shown to independently predict response to 5-AZA. In the survival analysis, the IPSS and IPSS-R risk classification systems along with the ECOG PS and SF levels > 520 ng/ml proved to be independent prognosticators for overall survival (OS), as well as for leukemia-free survival (LFS). Next, we built new multivariate models for OS and LFS, incorporating only ECOG PS and SF levels besides IPSS or IPSS-R risk classification systems. Thereby, the new modified IPSS and IPSS-R risk classification systems (H-PSS, H-PSS-R) could each discriminate a low, an intermediate and a high-risk patient group regarding OS and LFS. The H-PSS and H-PSS-R proved to be better predictors of OS than their previous counterparts as well as the French prognostic score, while the most powerful OS predictor was the new, H-PSS-R system. Conclusions: ECOG PS and SF levels > 520 ng/ml independently predict response to 5-AZA, OS and LFS. Their incorporation in the IPSS and IPSS-R scores enhances these scores’ predictive power in 5-AZA-treated higher-risk MDS and oligoblastic AML patients.

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Prognostic impact of elevated pretreatment serum ferritin in patients with high-risk MDS treated with azacitidine

Cited by 8 publications

References 19 publications

Association of Serum Ferritin Levels Before Start of Conditioning With Mortality After alloSCT – A Prospective, Non-interventional Study of the EBMT Transplant Complications Working Party

Association of Serum Ferritin Levels Before Start of Conditioning With Mortality After alloSCT – A Prospective, Non-interventional Study of the EBMT Transplant Complications Working Party

Real-World Outcome and Prognostic Factors in MDS Patients Treated with Azacitidine—A Retrospective Analysis

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