Prognostic impact of elevated pretreatment serum ferritin in patients with high-risk MDS treated with azacitidine
Related Experiment Video
Updated: Feb 9, 2026
Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
Kamel Laribi1, Delphine Bolle2, Mustapha Alani1
1Department of Hematology, Centre Hospitalier Le Mans, Le Mans, France.
Abstract:
Iron overload has been associated with poor overall survival in patients with higher-risk myelodysplastic syndromes after allogeneic hematopoietic stem cell transplantation, but has not been investigated in higher-risk MDS patients treated with hypomethylating agents. We evaluated the prognostic value of serum ferritin levels at diagnosis in a retrospective analysis of 48 patients with an intermediate 2 or high-risk International Prognostic Scoring System (IPSS) score treated with azacytidine. overall survival probability at 1 and 2 years was 58% and 42%, respectively. When stratifying according to serum ferritin level at azacytidine initiation, patients with serum ferritin level <725 ng/mL had significantly better OS than those with serum ferritin level ≥725 ng/mL, with an overall survival probability of 74% (95% confidence interval [CI]: 58-94) versus 44% (95% CI: 28-68) at 1 year and 57% (95% CI: 39-81) versus 28% (95% CI: 15-52) at 2 years, respectively (p = 0.034). Median progression-free survival was 16.15 months (range: 9-26) for the entire cohort. Progression-free survival probabilities according to serum ferritin cut-off level <725 ng/mL or ≥725 ng/mL at 1 and 2 years were 70% (95% CI: 53-91) versus 44 (95% CI: 28-68) and 52% (95% CI: 35-77) versus 24% (95% CI: 12-48), respectively (p = 0.031). We have demonstrated that an serum ferritin level ≥725 ng/mL was associated with worse overall survival and progression-free survival when adjusting for other covariables in multivariate analysis, in addition, unfavorable karyotype led to worse outcome. In conclusion, we believe that that negative effect of serum ferritin level on overall survival is not only related to the iron toxicity, but most probably may also be considered as a surrogate marker for very ineffective erythropoiesis leading to marked anemia.
Insights
High serum ferritin levels (≥725 ng/mL) indicate poor survival outcomes in myelodysplastic syndromes patients treated with azacitidine. Lower ferritin levels correlate with significantly better overall and progression-free survival, suggesting iron overload
Area of Science:
- Hematology
- Oncology
Background:
- Iron overload is linked to poor survival in higher-risk myelodysplastic syndromes (MDS) post-hematopoietic stem cell transplantation.
- Its prognostic value in higher-risk MDS patients treated with hypomethylating agents remains under-investigated.
Purpose of the Study:
- To evaluate the prognostic significance of serum ferritin levels at diagnosis in higher-risk MDS patients receiving azacitidine.
Main Methods:
- Retrospective analysis of 48 patients with intermediate-2 or high-risk International Prognostic Scoring System (IPSS) scores treated with azacitidine.
- Serum ferritin levels were assessed at the initiation of azacitidine therapy.
Main Results:
- Patients with serum ferritin <725 ng/mL had significantly better overall survival (OS) and progression-free survival (PFS) compared to those with levels ≥725 ng/mL.
- Multivariate analysis confirmed that serum ferritin ≥725 ng/mL was associated with worse OS and PFS.
- Unfavorable karyotype also correlated with poorer outcomes.
Conclusions:
- Elevated serum ferritin (≥725 ng/mL) is a significant negative prognostic factor for survival in higher-risk MDS patients treated with azacitidine.
- High ferritin may reflect iron toxicity or serve as a marker for ineffective erythropoiesis and severe anemia.
Related Concept Videos
03:12Freezing Point Depression and Boiling Point Elevation
The boiling point of a liquid is the temperature at which its vapor pressure is equal to ambient atmospheric pressure. Since the vapor pressure of a solution is lowered due to the presence of nonvolatile solutes, it stands to reason that the solution’s boiling point will subsequently be increased. Vapor pressure increases with temperature, and so a solution will require a higher temperature than will pure solvent to achieve any given vapor pressure, including one...
01:12Relative Risk
01:19Impact of Groups on Groups
01:20Elevation of Intermediate Points on Vertical Curves
01:30Impact
When particles with different initial velocities collide, they induce deformation by applying equal and opposite impulses. At the point of maximum deformation, the particles move together with...
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...