title: Red blood cell transfusion need at diagnosis adversely affects survival in primary myelofibrosis-increased serum ferritin or transfusion load does not.
abstract: Serum ferritin level at diagnosis was available in 185 patients with primary myelofibrosis (PMF); twenty-two (12%) patients had serum ferritin >1,000 ng/mL and 32 (17%) were red blood cell (RBC) transfusion-dependent. As expected, RBC transfusion need and increased serum ferritin displayed strong correlation (P < 0.0001); in addition, the latter but not the former correlated with advanced age (P < 0.0001). During median follow-up of 28 months (range 0.5-231), peak serum ferritin levels exceeded 1,000 ng/mL in 41 (22%) patients. On multivariable analysis that included age as a covariate, RBC transfusion need at diagnosis (P < 0.0001), but not increased serum ferritin or transfusion load, predicted shortened survival. The prognostic relevance of RBC transfusion need was independent of the International Prognostic Scoring System and was also illustrated for leukemia-free survival (P = 0.003). In PMF, the presence of a more severe erythropoietic defect, and not iron overload, has additional adverse prognostic value.
authors.affiliation: Division of Hematology Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. tefferi.ayalew@mayo.edu
authors.forename: Ayalew
authors.initials: A
authors.lastname: Tefferi
authors.forename: Ruben A
authors.initials: RA
authors.lastname: Mesa
authors.forename: Animesh
authors.initials: A
authors.lastname: Pardanani
authors.forename: Kebede
authors.initials: K
authors.lastname: Hussein
authors.forename: Susan
authors.initials: S
authors.lastname: Schwager
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Hanson
authors.forename: David P
authors.initials: DP
authors.lastname: Steensma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017707:Erythrocyte Transfusion; D005260:Female; D005293:Ferritins / Q000097:blood*; D006801:Humans; D019190:Iron Overload / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D055728:Primary Myelofibrosis / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
chemical_list: D005293:Ferritins