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

Abstract

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.

Characteristics of the Distribution of Ferritin in Epithelial Ovarian Tumor Patients: Results of a Retrospective, Observational Study

“…These results showed that the expression of ferritin is positively correlated with tumor growth. As mentioned above, recent studies revealed that the higher ferritin expression in malignant tumors is related to myelodysplastic syndromes [14], cancer metastasis [15] [16], drug resistance [5] [6], and poor prognosis [17]. The higher ferritin expression determined in our study makes further investigations necessary to elucidate the function of ferritin in different compartments of cancer cells.…”

Myelodysplastic syndromes: 2018 update on diagnosis, risk‐stratification and management

“…This survival advantage remained after matched pair analysis adjusting for age, frailty, comorbidity and R‐IPSS. However, there are no randomized prospective studies demonstrating superior outcomes with iron chelation therapy and there is controversial data with regard to the serum ferritin threshold which should trigger chelation . The NCCN guidelines recommend the use of chelation therapy in patients with ferritin levels above 2500 ng/mL .…”

Serum ferritin is a different predictor from transfusion history for allogeneic transplantation outcome in patients with severe aplastic anemia

“…During the early 10 years, numerous studies have shown that elevated SF prior to HSCT is detrimental to OS with an increase in nonrelapse mortality, as a consequence of iron overload toxicity [6][7][8][9][10]. However, the enrollments in many previous articles always included various diseases, including AA, myelodysplastic syndromes, and acute or chronic hematologic malignancies [3,11,12]. As it is still unknown whether SF plays the same role in different hematologic diseases, and patients with those different kinds of diseases also received different amounts of RBC transfusion, we enrolled only SAA patients this time.…”

“…There have been numerous studies that have revealed the association between iron overload and allogeneic hematopoietic stem cell transplantation (allo-HSCT), and most investigators preferred serum ferritin (SF) as an indicator of iron burden, as well as an acute phase reactant [1]. However, controversies still exist over whether high-ferritin equals iron overload, and whether it leads to poor outcome [3].…”