Sunnybrook Health Sciences Centre, Toronto, ON.
Tom Baker Cancer Centre, Calgary, AB.
Haematologica. 2023 Feb 1;108(2):532-542. doi: 10.3324/haematol.2022.280723.
Iron overload (IO) reflected by elevated ferritin is associated with increased mortality in myelodysplastic syndromes (MDS), however, ferritin is an imperfect metric. Elevated labile plasma iron correlates with clinical outcomes and transferrin saturation (TSAT) >80%, but is not readily measurable. The trajectory of TSAT, and its association with clinical outcomes remain undefined. Canadian MDS registry patients were evaluated. Mean TSAT, mean ferritin and transfusion dose density (TDD) were determined. Survival was evaluated by TSAT and ferritin (<50%, 50-80%, >80%), (≤500 μg/L, 501-800 μg/L, >800 μg/L). In 718 patients, median age was 74 years; 12%, 31%, 29%, 15% and 13% were IPSS-R very low, low, intermediate, high and very high. TSAT and ferritin were moderately correlated (r=0.63, P<0.0001). TSAT increased over time in transfusion- dependent patients (P=0.006). Higher TSAT and ferritin were associated with inferior 5-year overall (OS), progression- free (PFS), and leukemia-free survival (LFS) (P≤0.008) and higher TDD with inferior 5-year OS. TSAT >80% trended with inferior cardiac death-free survival (P=0.053). In univariate analysis, age, IPSS-R, blast percentage by Eastern Cooperative Oncology Group Performance Status, frailty, Charlson Comorbidity Index, iron chelation (Y/N), TDD, TSAT and ferritin were significantly associated with inferior OS. By multivariable analysis, TSAT >80% (P=0.007) remained significant for OS (R2 30.3%). In MDS, TSAT >80% and ferritin >800 μg/L portended inferior OS, PFS and LFS. TSAT may indicate the presence of oxidative stress, and is readily measurable in a clinical setting. The relationship between TSAT and cardiac death-free survival warrants further study.
铁过载（IO）表现为铁蛋白升高与骨髓增生异常综合征（MDS）患者的死亡率增加有关，然而铁蛋白并不是一个完美的指标。不稳定的血浆铁升高与临床结局相关，且转铁蛋白饱和度（TSAT）＞80%，但不易测量。TSAT 的轨迹及其与临床结局的关系尚不清楚。评估了加拿大 MDS 登记处的患者。确定平均 TSAT、平均铁蛋白和输血剂量密度（TDD）。通过 TSAT 和铁蛋白（＜50%、50-80%、＞80%）、（≤500μg/L、501-800μg/L、＞800μg/L）评估生存情况。在 718 名患者中，中位年龄为 74 岁；12%、31%、29%、15%和 13%分别为 IPSS-R 极低、低、中、高和极高。TSAT 和铁蛋白呈中度相关（r=0.63，P＜0.0001）。依赖输血的患者的 TSAT 随时间增加（P=0.006）。较高的 TSAT 和铁蛋白与较差的 5 年总生存（OS）、无进展生存（PFS）和白血病无生存（LFS）相关（P≤0.008），较高的 TDD 与较差的 5 年 OS 相关。TSAT＞80%与较差的心脏死亡无生存相关（P=0.053）。在单变量分析中，年龄、IPSS-R、Eastern Cooperative Oncology Group 体能状态的骨髓原始细胞百分比、虚弱、Charlson 合并症指数、铁螯合（Y/N）、TDD、TSAT 和铁蛋白与较差的 OS 显著相关。多变量分析中，TSAT＞80%（P=0.007）仍然与 OS 显著相关（R2 30.3%）。在 MDS 中，TSAT＞80%和铁蛋白＞800μg/L预示着 OS、PFS 和 LFS 较差。TSAT 可能表明存在氧化应激，并且在临床环境中易于测量。TSAT 与心脏死亡无生存之间的关系值得进一步研究。
