Akut Miyeloid Lösemi Hastalarında Demir Yüklenme Durumunun Klinik ve Prognostik Önemi

Abstract

ABSTRACT Açıkgöz ŞA. Clinical and Prognostic Significance of Iron Overload Status in Acute Myeloid Leukemia Patients. Hacettepe University Faculty of Medicine, Department of Internal Medicine, Thesis in Internal Medicine, Ankara 2015. Purpose: In this retrospective study, we aimed to determine the iron overload and its clinical and prognostic effects by evaluating serum iron parameters at the time of diagnosis in acute myeloid leukemia (AML) patients who diagnosed in Hacettepe University Hospitals between 2001 and 2015. Material and Method: One hundred and three AML patients whose serum iron tests were available at the time of diagnosis were followed by Hacettepe University Hospitals, Department of Hematology in between December 2001 and April 2015 were included in this study. Twenty one patients with a history of myelodysplastic syndromes (MDS) or other chronic hematopoietic diseases were excluded from the study because of probably affecting the serum iron tests. The medical histories, demographic characteristics, bone marrow aspiration/biopsy and cytogenetic analysis records of patients and their cytotoxic chemotherapy responses and final outcomes were examined. The frequency of iron overload status and its association with clinical factors were evaluated based on different threshold levels of transferrin saturation (TS) and ferritin. Results: The mean transferrin saturation and ferritin levels of 82 AML patients who eligible for the study were %55±%25 and 1138±1742 ng/mL, respectively. Forty two patients’ (%51,2) transferrin saturation were higher than %50 and 26 patients’ (%31,7) ferritin levels were higher than 1000 ng/mL which is the threshold level of iron chelation. When the threshold of iron overload of transferrin saturation and ferritin levels were determined as %80 and 700 ng/mL at AML patients which were treated by intensive treatment; %53,3 of patients with TS≥%80 had been induction mortality, %16,1 of patients with TS<%80 were exitus during the induction chemotherapy (p=0,009). The rates of induction mortalities between the patients with ferritin≥700 ng/mL and ferritin<700 ng/mL were %41,4 and %10,9 respectively (p=0,001). Similar results were found in groups which TS and ferritin values evaluated together (p=0,001). When the threshold of iron overload of transferrin saturation was determined as %60, iron overload was associated with myelodysplasia-treatment related AML group (p=0,029). Iron overload was not associated with overall and disease free survival of AML patients. Conclusion: Even iron overload was not associated with overall and disease free survival of AML patients, by the contribution of similar studies in the future, iron overload status will be add to the treatment related mortality scoring systems about AML, because of association with induction mortality in this study. Based on studies related to iron overload and MDS, this is the first study to determine the associations between iron overload and myelodysplasia-treatment related AML which has similar cytogenetic and dysplastic features with MDS. Our results should be supported by prospective, large sample size studies. Keywords: Acute myeloid leukemia, iron overload