International Journal of Hematology

DOI: 10.1007/s12185-019-02710-1 Pages: 533-542

Serum ferritin levels at diagnosis predict prognosis in patients with low blast count myelodysplastic syndromes

1. Kyoto University, Department of Hematology and Oncology, Graduate School of Medicine

2. Kanazawa Medical University, Department of Hematology and Immunology

3. NTT Medical Center Tokyo, Department of Hematology

4. Kawasaki Medical School, Department of Laboratory Medicine

5. International Medical Center, Saitama Medical University, Department of Hemato-Oncology

6. Saitama Medical University, Division of Hematology, Department of Internal Medicine, Faculty of Medicine

7. Nagasaki University, Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute

8. Kitasato University School of Medicine, Department of Hematology

9. Saitama Medical University, School of Medical Technology, Faculty of Health and Medical Care

10. Dokkyo Medical University Hospital, Clinical Laboratory Center

11. University of Tsukuba, Department of Hematology, Faculty of Medicine

12. Kobe City Medical Center General Hospital, Department of Hematology

13. Medical Research Institute Kitano Hospital, Department of Hematology

14. Japanese Red Cross Wakayama Medical Center, Department of Hematology

15. The University of Tokyo, Department of Hematology and Oncology, Graduate School of Medicine

16. Tokyo Metropolitan Police Hospital, Department of Hematology

17. Dokkyo Medical University School of Medicine, Department of Hematology and Oncology

Correspondence to:
Hiroshi Kawabata



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.

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