Myelodysplastic syndromes (MDS) patients who have low levels of an iron-binding protein prior to stem cell transplantation may have longer survival after the procedure than those with high levels of the protein.
Stem cell transplantation is a procedure in which a donor’s healthy bone marrow stem cells are used to replace a patient’s unhealthy bone marrow stem cells. Stem cell transplantation is the only known potential cure for MDS, but there is also a significant risk of complications or relapse after transplantation.
To identify factors that are associated with better patient outcomes after stem cell transplantation, the researchers retrospectively analyzed 35 MDS patients who received donor stem cell transplants from 1998 to 2010.
The researchers found that prior to transplantation 23 percent of patients had low levels (less than 1,000 ng/ml) of ferritin, a protein found in the blood that is able to bind and store iron. Additionally, these patients with lower ferritin levels had a median survival that was five times longer than patients with higher ferritin levels.
In addition, MDS patients who did not progress to acute myeloid leukemia had significantly longer survival (1157 days) than those who progressed (109 days).
There was also a trend toward better survival for patients who achieved complete remission prior to stem cell transplantation. Achieving complete remission within the first 100 days after transplantation was associated with a significant improvement in survival.
The median overall survival for the entire group of patients was 316 days from the time of transplantation. Following transplantation, 77 percent of patients were alive at 100 days, 47 percent at 1 year, and 31 percent at 3 years.
The most common cause of death during the first 100 days after transplantation was infection. After the first 100 days, the most common cause of death was graft-versus-host disease, in which the donor’s cells recognize the patient’s cells as foreign and attack them.
Illustration: Structure of ferritin. –D.M. Lawson et al on The Protein Data Bank.
The MDS Beacon (06/14/11)
Abstract (2011 American Society of Clinical Oncology Annual Meeting; Abstract No. 6562; Journal of Clinical Oncology; 29 (2011))