Prognostic significance of serum ferritin level at diagnosis in myelodysplastic syndrome.

Myelodysplastic syndrome (MDS) is characterized by peripheral blood cytopenias and risk of progression to acute myeloid leukemia. Elevated serum ferritin (SF), due to ineffective erythropoiesis and increased iron absorption from the gut, is often observed in non-transfused MDS patients, suggesting involvement of iron overload in its pathogenesis. However, the prognostic value of the baseline SF is unclear. We evaluated baseline SF levels in non-transfused MDS patients. The SF level was significantly higher in the 47 MDS patients in this study than in the healthy controls (P < 0.001). The SF level of higher-risk MDS patients (int-2/high) was significantly higher than that of the lower-risk MDS patients (low/int-1) (467 ± 354 vs. 277 ± 372 ng/ml, P < 0.001). The SF level in MDS patients with chromosomal abnormality was significantly higher than that in patients with normal karyotype. When patients were divided into the low SF group (<500 ng/ml) and high SF group (≥500 ng/mL), the survival time was significantly longer in the former group than the latter group (118.8 vs. 10.2 M, P = 0.002). Further, leukemia-free survival (LFS) was significantly longer in the low SF group than the high SF group (P = 0.010). Baseline SF level may, therefore, be a prognostic factor for overall survival and LFS in MDS patients.