Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Hematology and Immunology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa-ken, 920-0293, Japan.
Int J Hematol. 2019 Nov;110(5):533-542. doi: 10.1007/s12185-019-02710-1. Epub 2019 Jul 29.
Serum ferritin, a marker of systemic iron status, is considered a prognostic factor for patients with myelodysplastic syndromes (MDS), despite the lack of supporting evidence. We investigated the association between serum ferritin levels at diagnosis and the prognoses of Japanese MDS patients with bone marrow blasts < 5% and peripheral blood blasts < 2%. Three hundred and ninety patients with cytopenia were registered prospectively in the multicenter database, among whom 107 patients with MDS (72 males and 35 females, with a median age of 70 years) met the eligibility criteria. The median serum ferritin level at diagnosis was 204 ng/mL; we divided the cohort into low (n = 56) and high (n = 51) ferritin groups using a cutoff of 210 ng/mL. Kaplan-Meier analyses revealed that the 3-year overall survival (OS) of the high ferritin group was significantly shorter than that of the low ferritin group (66% and 79%, respectively). The cumulative incidences of leukemic progression were similar between the groups. On multivariate analysis, age, blast percentage, cytogenetic abnormalities, and serum ferritin levels at diagnosis were independently associated with OS in our patients. Thus, modest elevations of ferritin levels at diagnosis may influence the prognoses of patients with MDS who have low blast counts.
血清铁蛋白是反映全身铁状态的标志物，被认为是骨髓增生异常综合征（MDS）患者的预后因素，但缺乏支持证据。我们研究了日本骨髓原始细胞<5%和外周血原始细胞<2%的 MDS 患者诊断时血清铁蛋白水平与预后之间的关系。390 例血细胞减少症患者前瞻性地在多中心数据库中注册，其中 107 例 MDS 患者（72 名男性和 35 名女性，中位年龄 70 岁）符合入选标准。诊断时的中位血清铁蛋白水平为 204ng/mL；我们使用 210ng/mL 的截值将队列分为低铁蛋白组（n=56）和高铁蛋白组（n=51）。Kaplan-Meier 分析显示，高铁蛋白组的 3 年总生存（OS）显著短于低铁蛋白组（分别为 66%和 79%）。两组之间白血病进展的累积发生率相似。多变量分析显示，年龄、原始细胞百分比、细胞遗传学异常和诊断时的血清铁蛋白水平与患者的 OS 独立相关。因此，诊断时铁蛋白水平的适度升高可能会影响低原始细胞计数 MDS 患者的预后。
