Gunnar Birgegard1, Jan Samuelsson2, Erik Ahlstrand3, Elisabeth Ejerblad1, Christian Enevold4, Waleed Ghanima5, Hans Hasselbalch6, Claus H Nielsen6, Håvar Knutsen7, Ole B Pedersen8, Anders Sørensen4,6, Björn Andreasson9. 1. Department of Medical Sciences, Uppsala University, Uppsala, Sweden. 2. Department of Hematology, University Hospital Linkoping, Linkoping, Sweden. 3. Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. 4. Institute for Inflammation Research, Copenhagen University Hospital, Copenhagen, Denmark. 5. Department of Research, Østfold Hospital, Sarpsborg, Norway. 6. Department of Hematology, Zealand University Hospital, Roskilde, Denmark. 7. Department of Hematology, Ullevål Hospital, Oslo, Norway. 8. Department of Clinical Immunology, Naestved Hospital, Naestved, Denmark. 9. Hematology Section, Specialist Medicine, NU Hospital Group, Uddevalla, Sweden.
Abstract
OBJECTIVES: The study investigates the hypothesis that inflammation in myelofibrosis (MF) like in myeloma and lymphoma, may disturb iron distribution and contribute to anaemia. METHODS: A cross-sectional study of 80 MF and 23 ET patients was performed. RESULTS: About 35% of anaemic MF patients had functional iron deficiency (FID) with transferrin saturation <20 and normal or elevated S-ferritin (<500 µg/L). In ET, FID was rare. In MF patients with FID, 70.6% were anaemic, vs 29.4% in patients without FID (P = 0.03). Hepcidin was significantly higher in MF patients with anaemia, including transfusion-dependent patients, 50.6 vs 24.4 µg/L (P = 0.01). There was a significant negative correlation between Hb and inflammatory markers in all MF patients: IL-2, IL-6 and TNF-α, (P < 0.01-0.03), LD (P = 0.004) and hepcidin (P = 0.03). These correlations were also seen in the subgroup of anaemic MF patients (Table ). Tsat correlated negatively with CRP (P < 0.001). Symptom burden was heavier in MF patients with FID, and MPN-SAF quality of life scores correlated with IL-6 and CRP. CONCLUSIONS: The inflammatory state of MF disturbs iron turnover, FID is common and contributes to anaemia development and impairment of QoL. Anaemic MF patients should be screened for FID.
OBJECTIVES: The study investigates the hypothesis that inflammation in myelofibrosis (MF) like in myeloma and lymphoma, may disturb iron distribution and contribute to anaemia. METHODS: A cross-sectional study of 80 MF and 23 ET patients was performed. RESULTS: About 35% of anaemic MF patients had functional iron deficiency (FID) with transferrin saturation <20 and normal or elevated S-ferritin (<500 µg/L). In ET, FID was rare. In MF patients with FID, 70.6% were anaemic, vs 29.4% in patients without FID (P = 0.03). Hepcidin was significantly higher in MF patients with anaemia, including transfusion-dependent patients, 50.6 vs 24.4 µg/L (P = 0.01). There was a significant negative correlation between Hb and inflammatory markers in all MF patients: IL-2, IL-6 and TNF-α, (P < 0.01-0.03), LD (P = 0.004) and hepcidin (P = 0.03). These correlations were also seen in the subgroup of anaemic MF patients (Table ). Tsat correlated negatively with CRP (P < 0.001). Symptom burden was heavier in MF patients with FID, and MPN-SAF quality of life scores correlated with IL-6 and CRP. CONCLUSIONS: The inflammatory state of MF disturbs iron turnover, FID is common and contributes to anaemia development and impairment of QoL. Anaemic MF patients should be screened for FID.
Authors: Aaron T Gerds; Prithviraj Bose; Gabriela S Hobbs; Andrew T Kuykendall; Lynn M Neilson; Jinlin Song; Barbara Klencke; Claire N Harrison Journal: Hemasphere Date: 2022-09-30