The clinical and prognostic implications of serum iron tests in acute myeloid leukemia with myelodysplasia-related changes

Objective: The aim of this study was to investigate the relationship between demographic and clinical parameters of AML with Myelodysplasia-Related Changes (AML-MRC) patients and other de-novo AML patients, and also between subgroups of AML-MRC. We also compared serum iron overload at the time of diagnosis in AML-MRC and non AML-MRC patients. We wanted to provide a critique of the method on how we diagnose myelodysplasia in patients with AML. Materials and Methods: 93 patients who met the criteria were enrolled, bone marrow aspirate of each patient was re-examined and dysplasia was investigated, and other records were examined from patient files. The iron overload status at diagnosis and transferrin saturation (TS) values were compared between the groups with and without multilineage dysplasia (MLD) and those with and without AML-MRC. Patients were also divided into AML subgroups and compared in terms of clinical and demographic parameters. Results: There was no statistically significant difference in demographic and clinical parameters between patients with and without AML-MRC. All three series could be evaluated in only 32% (n=30) of patients and 55 patients (59%) could be evaluated adequately for dysplasia. Median disease-free survival of patients with MLD (n = 27) was observed for 11.5 months, but was lower than for those without, but not statistically significant (p = 0.093). AML-MRC patients diagnosed only by cytogenetics were less likely to receive intensive treatment and less likely to go into remission (p <0,05 for both). When iron overload was defined as TS ≥ 58% and ferritin ≥ 500 ng / mL, it was observed in 10 (37%) of the patients with MLD and 4 (13%) of the patients without MLD(p = 0.053). When iron loading is defined in the same way, sensitivity is estimated as 40.6% and specificity is 92.8% in terms of AML-MRC diagnosis. The positive predictive value was 92.8% and the negative predictive value was 40.6%. The mean TS value was higher and the iron overload rate was higher at the time of diagnosis (p <0,05 for both) compared to the others. There was a weak but statistically significant correlation between the total dysplasia severity score and TS on the positive side (r = 0,317, p=0,032). Conclusion: The mean TS and iron overload rate in AML-MRC patients is higher at diagnosis. AML_MRC patients diagnosed only with cytogenetics have a clinically worse course of disease. Many of the AML patients can not be adequately assessed for dysplasia due to blastic infiltration in the bone marrow. Keywords: Acute Myeloid Leukemia, AML with Myelodysplasia Related Changes, iron overload, histomorphological examination