Περίληψη:
Red blood cell transfusions remain one of the cornerstones in supportive care of lower-risk patients with myelodysplastic syndromes. We hypothesized that patients develop oxidant-mediated tissue injury through the formation of toxic iron species, caused either by red blood cell transfusions or by ineffective erythropoiesis. We analyzed serum samples from 100 lower-risk patients with myelodysplastic syndromes at six-month intervals for transferrin saturation, hepcidin-25, growth differentiation factor 15, soluble transferrin receptor, non-transferrin bound iron and labile plasma iron in order to evaluate temporal changes in iron metabolism and the presence of potentially toxic iron species and their impact on survival. Hepcidin levels were low in 34 patients with ringed sideroblasts compared to 66 patients without. Increases of hepcidin and non-transferrin bound iron levels were visible early in follow-up of all transfusion-dependent patient groups. Hepcidin levels significantly decreased over time in transfusion-independent patients with ringed sideroblasts. Increased soluble transferrin receptor levels in transfusion-independent patients with ringed sideroblasts confirmed the presence of ineffective erythropoiesis and suppression of hepcidin production in these patients. Detectable labile plasma iron levels in combination with high transferrin saturation levels occurred almost exclusively in patients with ringed sideroblasts and all transfusiondependent patient groups. Detectable labile plasma iron levels in transfusion-dependent patients without ringed sideroblasts were associated with decreased survival. In conclusion, toxic iron species occurred in all transfusion-dependent patients and in transfusion-independent patients with ringed sideroblasts. Labile plasma iron appeared to be a clinically relevant measure for potential iron toxicity and a prognostic factor for survival in transfusion-dependent patients. © 2018 Ferrata Storti Foundation.
Συγγραφείς:
de Swart, L.
Reiniers, C.
Bagguley, T.
van Marrewijk, C.
Bowen, D.
Hellström-Lindberg, E.
Tatic, A.
Symeonidis, A.
Huls, G.
Cermak, J.
van de Loosdrecht, A.A.
Garelius, H.
Culligan, D.
Macheta, M.
Spanoudakis, M.
Panagiotidis, P.
Krejci, M.
Blijlevens, N.
Langemeijer, S.
Droste, J.
Swinkels, D.W.
Smith, A.
de Witte, T.
EUMDS Steering Committee
Λέξεις-κλειδιά:
C reactive protein; ferritin; hemoglobin; hepcidin; iron; soluble transferrin receptor; transferrin; transferrin receptor; transferrin saturation; unclassified drug; biological marker; erythropoietin; iron, 5q- syndrome; adult; aged; Article; blood transfusion; cell membrane; clinical evaluation; erythrocyte transfusion; erythroid precursor cell; erythropoiesis; female; ferritin blood level; hematological parameters; human; human cell; International Prognostic Scoring System; iron blood level; iron chelation; iron metabolism; iron overload; iron therapy; labile plasma iron; leukocyte; low risk patient; major clinical study; male; myelodysplastic syndrome; overall survival; prediction; prognosis; progression free survival; refractory anemia; refractory anemia with excess blasts; refractory anemia with ringed sideroblasts; refractory cytopenia with multilineage dysplasia; refractory cytopenia with multilineage dysplasia and ringed sideroblasts; survival time; thrombocyte; very elderly; blood; clinical trial; iron overload; metabolism; middle aged; mortality; multicenter study; myelodysplastic syndrome; procedures; proportional hazards model, Adult; Aged; Aged, 80 and over; Biomarkers; Blood Transfusion; Erythropoietin; Female; Humans; Iron; Iron Overload; Male; Middle Aged; Myelodysplastic Syndromes; Prognosis; Proportional Hazards Models
