Observational Monitoring of Patients with Aplastic Anemia and Low/Intermediate-1 Risk of Myelodysplastic Syndromes Complicated with Iron Overload

Abstract

Background: This study focuses on the iron overload (IOL) of patients with transfused aplastic anemia (AA) or a low/intermediate-1 risk of myelodysplastic syndrome (MDS). Methods: Ninety-two AA or MDS patients with IOL were prospectively recruited. Clinical data were collected every 6 months, and organ magnetic resonance imaging T2* values were collected annually. Patients with IOL were chelated. Results: Serum ferritin was correlated with liver T2* and pancreatic T2* in the AA and MDS groups. Transfusion amounts were correlated with serum ferritin values, liver T2*, and pancreatic T2* in the AA group. At the 6-month and 1-year evaluations, patients with sufficient chelation experienced significant decreases in serum ferritin, and those with decreased serum ferritin experienced an obvious increase in hemoglobin. At their 1-year-follow-up, patients with adequate chelation showed significant increases in hepatic T2*, cardiac T2*, and left ventricular ejection fraction (LVEF). Patients with decreased serum ferritin (including those without chelation) experienced an increase in hemoglobin, hepatic T2*, cardiac T2*, and LVEF. Conclusion: The transfusion amount was more reliable at predicting IOL in patients with AA than in those with MDS. Adequate iron chelation can decrease serum ferritin levels and may improve hepatic T2*, cardiac T2*, and LVEF levels. A decrease in serum ferritin, even in the absence of chelation, may also benefit patients.

Clinical Complications of Iron Overload in Patients with Myelodysplastic Syndromes: a literature review

“…The accumulation of iron in organs of patients with MDS is a finding present in the disease, with the liver, heart and pancreas being the most affected organs [7,11].…”

Red blood cell transfusion in myelodysplastic syndromes: A systematic review

“…Du et al 12 "in the MDS group, no correlations were found between the transfusion amount and serum ferritin or MRI T2*" Frytak et al 13 "The economic burden of MDS is high for both transfusion-dependent and transfusion-independent patients, but can be especially onerous for those who are transfusion-dependent. "…”

“…Nine studies reported outcomes relating to iron overload and its complications. 10,12,19,24,27,30,32,37,43 Three studies found an increased risk of iron overload complications among transfused MDS patients, including presentations of cardiomyopathy/heart failure, conduction disorders, diabetes and liver disease. 10,27,30 Two studies examined magnetic resonance imaging evidence of iron deposition with conflicting results about the correlation between liver iron and transfusion burden.…”

“…10,27,30 Two studies examined magnetic resonance imaging evidence of iron deposition with conflicting results about the correlation between liver iron and transfusion burden. 12,32 Sixteen studies reported on non-iron overload related complications of transfusions in MDS patients. 8,9,11,15,17,[20][21][22][23]25,27,28,[34][35][36]38 One case series of MDS patients found transfusion-dependence prior to stem cell transplantation to be an independent risk factor for graftversus-host disease.…”

Magnetic Resonance Myocardial Feature Tracking in Transfusion-Dependent Myelodysplastic Syndrome

“…Myocardial iron overload (MIO) must be diagnosed with cardiac imaging techniques, because iron overload serum markers (ferritin and labile plasma iron) and/or the presence of hepatic siderosis do not correlate adequately with cardiac siderosis. 7) 8) T2* relaxation time measured by cardiac magnetic resonance (cMR) has become the gold standard parameter for the diagnosis and follow-up of these patients, 9) which is reduced in the presence of intramyocardial ferritin and hemosiderin.…”