Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2016, vol. 25, nr 4, July-August, p. 633–641

doi: 10.17219/acem/62397

Publication type: original article

Language: English

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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

Anna Waszczuk-Gajda1,A,B,C,D,E,F, Krzysztof Mądry1,A,B,C,E, Rafał Machowicz1,C,D,E, Joanna Drozd-Sokołowska1,B,C,E, Beata Stella-Hołowiecka2,B,C, Andrzej Mital3,B, Agata Obara4,B, Anna Szmigielska-Kapłon5,B, Anna Sikorska6,B, Edyta Subocz7,B, Wiesław W. Jędrzejczak1,F, Jadwiga Dwilewicz-Trojaczek1,A,C,D,E,F

1 Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Poland

2 Department of Hematology and Bone Marrow Transplantation, Silesian Medical University, Katowice, Poland

3 Department of Hematology and Bone Marrow Transplantation, Medical University of Gdańsk, Poland

4 Department of Hematology, Holycross Cancer Center, Kielce, Poland

5 Department of Hematology, Medical University of Lodz, Poland

6 Department of Hematology, Institute of Hematology and Transfusiology, Warszawa, Poland

7 Department of Hematology and Internal Diseases, Military Institute of Medicine, Warszawa, Poland

Abstract

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).
Conclusion. Taking into account the relatively low number of patients in previous studies exploring hyperferritinemia in MDS, the results of the first Polish MDS Registry provide important insights. Hyperferritinemia higher than 1000 ng/L can be an important indicator of poor prognosis in MDS.

Key words

myelodysplastic syndrome, hyperferritinemia, serum ferritin concentration, red blood cell transfusion dependence, transformation to acute myeloid leukemia

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