Research Of The Clinical Significance Of Iron Overload In Patients With Myelodysplastic Syndrome

Objective:The main causes of iron overload(SF?1000ug/L)in patients with myelodysplastic syndromes(MDS)are transfusion-dependence and ineffective hematopoiesis.Iron overload can reduce the life expectancy of MDS patients and increase their risk of conversion to acute myelogenous leukemia(AML).Iron chelation therapy can improve hematopoietic function and reduce transfusion dependence and improve the quality of life of patients.However,iron chelation therapy is not widely used in actual clinical work.In order to attract people's attention to the danger of iron overload,and applied iron removal therapy to clinical work,we studies the clinical significance of iron overload in patients with MDS in order to clarify the hazards of iron overload and the effect of iron chelation therapy on its survival.Methods:To retrospectively analyze the clinical data of hospitalized patients with first-time diagnosed MDS from the Department of Hematology of the First Central Hospital of Tianjin from January 2008 to October 2017,including gender,age,proportion of bone marrow blasts,WHO classification,and IPSS.Risk grouping,chromosome karyotype,serum ferritin value,blood routine,etc.The correlation between serum ferritin value(SF)and some clinical parameters(age,number of bone marrow blast cells,peripheral blood leukocyte count,absolute neutrophil count,hemoglobin concentration,platelet count,etc.)was statistically analyzed.The difference of these clinical parameters in the initial diagnosis of MDS patients with iron overload and non-iron overload were compared.The differences in the occurrence of iron overload between MDS different types,different IPSS risk groups,different karyotypes,and different genders were compared.The survival of patients with iron overload treated with iron-relieving MDS was compared with the survival of patients with iron overload who were not treated with iron deprivation.Results:1?One hundred and twenty patients with MDS diagnosed in our department for the first time were classified according to the WHO-MDS classification criteria(2016).Among them,thirty-four patients(33.3%)were diagnosed with MDS with single lineage dysplasiaa(MDS-SLD),twenty five patients(24.5%)were diagnosed with MDS with multilineage dysplasia,eight patients(7.8%)were diagnosed with MDS with excess blasts-1,twenty-six patients(25.5%)were diagnosed with MDS with excess blasts-2,eight patients(7.8%)were diagnosed with unclassifiable MDS,only one patients(1.0%)were diagnosed with MDS with isolated 5q deletion.There were63 males(61.8%)and 39 females(38.2%),with a median age of 66(24-95 years).According to the MDS's International Prognostic Score System(IPSS),the prognosis was divided into 8 cases(7.8%)with low risk,48 cases(47.1%)with intermediate risk,14(13.7%)with intermediate risk,and 15 cases with high risk(14.7%),17cases(16.7%)are unable to evaluate.Karyotype analysis: 52 cases(51.0%)with good prognosis,24 cases(23.5%)with moderate prognosis,9 cases(8.8%)with poor prognosis,and 17 cases(16.7)%)with failure of detection of fibroids 3 times in the banding;2?Among the 102 patients with the first diagnosis,45 patients(44.1%)with the serum ferritin values less than 500 ug/L,32 patients(31.4%)with the serum ferritin values ranged from 500 ug/L to 1000 ug/L,25 patients(24.5%)with the serum ferritin values more than 1000 ug/L;3?Among the 25 patients with iron overload,16 were males and 9 were females.The median age was 66 years(37-86 years).There was no correlation between age and serum ferritin values(P=0.791);4 ? There was no correlation between serum ferritin value and WBC count,absolute neutrophil count,hemoglobin concentration,platelet count,and proportion of bone marrow blast cells(P>0.05).There was a correlation between serum ferritin and survival(r=-0.2275,P=0.0292);5?There was no significant difference in the age,gender,white blood cell count,absolute neutrophil count,hemoglobin concentration,platelet count,and bone marrow blast cell count at the initial diagnosis of non-iron overload patients and iron overload patients(P>0.05).There was a statistically significant difference between group survival(P=0.0101);6 ? There was no statistically significant difference in the occurrence of ironoverload in the MDS subtypes(P=0.831).There was no significant difference in the occurrence of iron overload in the karyotype prognostic group of MDS(P=0.632).Iron overload occurred in the prognostic group of each MIPS IPSS group.The difference was not statistically significant(P=0.792);7?The survival time of iron-overloading patients treated with iron-deprived MDS was longer than that of iron-overload patients with MDS who had not undergone deferred iron treatment,the former has a higher overall survival rate than the latter..The difference was statistically significant(P=0.0376).Conclusion:In this study,iron overload was observed in 25 of 102 patients(24.5%)with newly diagnosed MDS(SF?1000 ?g/L);there was no correlation between serum ferritin levels,peripheral blood cell counts,and proportion of bone marrow blasts in different groups(WHO classification,and IPSS.Risk grouping,chromosome karyotype).There was no statistically significant difference in the occurrence of iron overload in patients with MDS;the overall survival of patients with iron overload was shorter than those without iron overload;the overall survival of patients with iron overload treated with iron chelation was significantly longer than that of patients without iron chelation,the former has a higher overall survival rate than the latter..