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High serum ferritin levels in newly diagnosed patients with myelodysplastic syndromes are associated with greater symptom severity


We examined the association between serum ferritin (SF) levels and patient-reported functional aspects and symptoms, as measured by the EORTC QLQ-C30, in newly diagnosed patients with myelodysplastic syndromes (MDS). Analysis was conducted on 497 MDS patients who were classified in two groups based on the SF value of 1000 ng/mL. Clinically relevant differences of patient-reported functional and symptom scales were evaluated and classified as small, medium and large, based on established thresholds. Multivariable linear regression analysis was performed to account for potential confounding factors. Patients with SF of ≥ 1000 ng/mL reported statistically significant and clinically relevant worse outcomes across various health domains. Dyspnea was the symptom indicating the largest difference and mean scores of patients with higher and lower SF levels were 40 and 24.3, respectively (p = 0.005), indicating a large clinically relevant difference (Δ = 15.7). Further research is needed to better understand the relationship between SF levels and specific health-related quality of life domains.

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The authors gratefully acknowledge all patients who participated in the GIMEMA-PROMYS Study for dedicating their time in completing quality of life questionnaires and having contributed in advancing knowledge in this research area. We also acknowledge the important contribution over the years to the coordination of the Data Management activities of Dr. Francesco Sparano.



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GC, FE designed the study and wrote the manuscript. FC, performed statistical analysis. All authors interpreted the data, read, commented on, and approved the final version of the manuscript.

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Correspondence to Fabio Efficace.

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Conflict of interests

Massimo Breccia: Honoraria by Novartis, Pfizer, Incyte, Celgene, outside the submitted work. Fabio Efficace: personal fees from Bristol-Myers Squibb, Amgen, Orsenix, Incyte and Takeda; grants from Amgen, outside the submitted work. Mario Luppi: Advisory Boards: Novartis, Gilead Sci, Abbvie, Celgene, MSD, Sanofi, Daiichi-Sankyo; Travel Grant Gilead sci, outside the submitted work. Giuseppe A. Palumbo: Honoraria from Jannsen, Novartis, Celgene, Amgen, outside the submitted work. Marco Vignetti: personal fees from Jazz Healthcare Italy SRL, Amgen, Millennium Pharmaceuticals Inc., Celgene, Janssen, Novartis and Incyte, outside the submitted work.

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Caocci, G., Vignetti, M., Patriarca, A. et al. High serum ferritin levels in newly diagnosed patients with myelodysplastic syndromes are associated with greater symptom severity. Int J Hematol 112, 141–146 (2020).

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  • Serum ferritin
  • Myelodysplastic syndromes
  • Functional status
  • Quality of life
  • Symptoms
  • Transfusions