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Serum ferritin levels at diagnosis predict prognosis in patients with low blast count myelodysplastic syndromes

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Abstract

Serum ferritin, a marker of systemic iron status, is considered a prognostic factor for patients with myelodysplastic syndromes (MDS), despite the lack of supporting evidence. We investigated the association between serum ferritin levels at diagnosis and the prognoses of Japanese MDS patients with bone marrow blasts < 5% and peripheral blood blasts < 2%. Three hundred and ninety patients with cytopenia were registered prospectively in the multicenter database, among whom 107 patients with MDS (72 males and 35 females, with a median age of 70 years) met the eligibility criteria. The median serum ferritin level at diagnosis was 204 ng/mL; we divided the cohort into low (n = 56) and high (n = 51) ferritin groups using a cutoff of 210 ng/mL. Kaplan–Meier analyses revealed that the 3-year overall survival (OS) of the high ferritin group was significantly shorter than that of the low ferritin group (66% and 79%, respectively). The cumulative incidences of leukemic progression were similar between the groups. On multivariate analysis, age, blast percentage, cytogenetic abnormalities, and serum ferritin levels at diagnosis were independently associated with OS in our patients. Thus, modest elevations of ferritin levels at diagnosis may influence the prognoses of patients with MDS who have low blast counts.

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References

  1. Ades L, Itzykson R, Fenaux P. Myelodysplastic syndromes. Lancet. 2014;383:2239–52.

    Article  PubMed  Google Scholar 

  2. Greenberg P, Cox C, LeBeau MM, Fenaux P, Morel P, Sanz G, et al. International scoring system for evaluating prognosis in myelodysplastic syndromes. Blood. 1997;89:2079–88.

    Article  CAS  PubMed  Google Scholar 

  3. Balduini CL, Guarnone R, Pecci A, Centenara E, Ascari E. International prognostic scoring system and other prognostic systems for myelodysplastic syndromes. Blood. 1997;90:4232–4.

    Article  CAS  PubMed  Google Scholar 

  4. Malcovati L, Germing U, Kuendgen A, Della Porta MG, Pascutto C, Invernizzi R, et al. Time-dependent prognostic scoring system for predicting survival and leukemic evolution in myelodysplastic syndromes. J Clin Oncol. 2007;25:3503–10.

    Article  PubMed  Google Scholar 

  5. Kantarjian H, O’Brien S, Ravandi F, Cortes J, Shan J, Bennett JM, et al. Proposal for a new risk model in myelodysplastic syndrome that accounts for events not considered in the original International Prognostic Scoring System. Cancer. 2008;113:1351–61.

    Article  CAS  PubMed  Google Scholar 

  6. Greenberg PL, Tuechler H, Schanz J, Sanz G, Garcia-Manero G, Sole F, et al. Revised international prognostic scoring system for myelodysplastic syndromes. Blood. 2012;120:2454–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Cohen LA, Gutierrez L, Weiss A, Leichtmann-Bardoogo Y, Dl Zhang, Crooks DR, et al. Serum ferritin is derived primarily from macrophages through a nonclassical secretory pathway. Blood. 2010;116:1574–84

    Article  CAS  PubMed  Google Scholar 

  8. Pileggi C, Di Sanzo M, Mascaro V, Marafioti MG, Costanzo FS, Pavia M. Role of serum ferritin level on overall survival in patients with myelodysplastic syndromes: results of a meta-analysis of observational studies. PLoS ONE. 2017;12:e0179016.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Lim ZY, Fiaccadori V, Gandhi S, Hayden J, Kenyon M, Ireland R, et al. Impact of pre-transplant serum ferritin on outcomes of patients with myelodysplastic syndromes or secondary acute myeloid leukaemia receiving reduced intensity conditioning allogeneic haematopoietic stem cell transplantation. Leuk Res. 2010;34:723–7.

    Article  CAS  PubMed  Google Scholar 

  10. Armand P, Kim HT, Cutler CS, Ho VT, Koreth J, Alyea EP, et al. Prognostic impact of elevated pretransplantation serum ferritin in patients undergoing myeloablative stem cell transplantation. Blood. 2007;109:4586–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Sakamoto S, Kawabata H, Kanda J, Uchiyama T, Mizumoto C, Kondo T, et al. Differing impacts of pretransplant serum ferritin and C-reactive protein levels on the incidence of chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. Int J Hematol. 2013;97:109–16.

    Article  CAS  PubMed  Google Scholar 

  12. Kikuchi S, Kobune M, Iyama S, Sato T, Murase K, Kawano Y, et al. Prognostic significance of serum ferritin level at diagnosis in myelodysplastic syndrome. Int J Hematol. 2012;95:527–34.

    Article  CAS  PubMed  Google Scholar 

  13. Laribi K, Bolle D, Alani M, Ghnaya H, Le Bourdelles S, Besancon A, et al. Prognostic impact of elevated pretreatment serum ferritin in patients with high-risk MDS treated with azacitidine. Exp Hematol. 2018;65:34–7.

    Article  CAS  PubMed  Google Scholar 

  14. Sotirova T, Stojanovic A, Genadieva-Stavric S, Krstevska S, Spasovski D, Balkanov T. Influence of prognostic factors on overall survival in myelodysplastic syndromes. Mater Sociomed. 2014;26:292–6.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kerkhofs H, Hermans J, Haak HL, Leeksma CH. Utility of the FAB classification for myelodysplastic syndromes: investigation of prognostic factors in 237 cases. Br J Haematol. 1987;65:73–81.

    Article  CAS  PubMed  Google Scholar 

  16. Kawabata H, Tohyama K, Matsuda A, Araseki K, Hata T, Suzuki T, et al. Validation of the revised International Prognostic Scoring System in patients with myelodysplastic syndrome in Japan: results from a prospective multicenter registry. Int J Hematol. 2017;106:375–84.

    Article  PubMed  Google Scholar 

  17. Bennett JM, Catovsky D, Daniel MT, Flandrin G, Galton DA, Gralnick HR, et al. Proposals for the classification of the myelodysplastic syndromes. Br J Haematol. 1982;51:189–99.

    Article  CAS  PubMed  Google Scholar 

  18. Goasguen JE, Bennett JM, Bain BJ, Brunning R, Vallespi MT, Tomonaga M, et al. Proposal for refining the definition of dysgranulopoiesis in acute myeloid leukemia and myelodysplastic syndromes. Leuk Res. 2014;38:447–53.

    Article  PubMed  Google Scholar 

  19. Mufti GJ, Bennett JM, Goasguen J, Bain BJ, Baumann I, Brunning R, et al. Diagnosis and classification of myelodysplastic syndrome: International Working Group on Morphology of myelodysplastic syndrome (IWGM-MDS) consensus proposals for the definition and enumeration of myeloblasts and ring sideroblasts. Haematologica. 2008;93:1712–7.

    Article  PubMed  Google Scholar 

  20. Gray RJ. A class of k-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16:1141–54.

    Article  Google Scholar 

  21. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  PubMed  Google Scholar 

  22. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al. editors. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon: International Agency for Research on Cancer (IARC); 2017.

    Google Scholar 

  23. Shenoy N, Vallumsetla N, Rachmilewitz E, Verma A, Ginzburg Y. Impact of iron overload and potential benefit from iron chelation in low-risk myelodysplastic syndrome. Blood. 2014;124:873–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Srai SK, Bomford A, McArdle HJ. Iron transport across cell membranes: molecular understanding of duodenal and placental iron uptake. Best Pract Res Clin Haematol. 2002;15:243–59.

    Article  CAS  PubMed  Google Scholar 

  25. Cui R, Gale RP, Zhu G, Xu Z, Qin T, Zhang Y, et al. Serum iron metabolism and erythropoiesis in patients with myelodysplastic syndrome not receiving RBC transfusions. Leuk Res. 2014;38:545–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Camaschella C, Nai A. Ineffective erythropoiesis and regulation of iron status in iron loading anaemias. Br J Haematol. 2016;172:512–23.

    Article  CAS  PubMed  Google Scholar 

  27. Gattermann N. Iron overload in myelodysplastic syndromes (MDS). Int J Hematol. 2018;107:55–63.

    Article  CAS  PubMed  Google Scholar 

  28. Kikuchi S, Kobune M, Iyama S, Sato T, Murase K, Kawano Y, et al. Improvement of iron-mediated oxidative DNA damage in patients with transfusion-dependent myelodysplastic syndrome by treatment with deferasirox. Free Radic Biol Med. 2012;53:643–8.

    Article  CAS  PubMed  Google Scholar 

  29. Moukalled NM, El Rassi FA, Temraz SN, Taher AT. Iron overload in patients with myelodysplastic syndromes: an updated overview. Cancer. 2018;124:3979–89.

    Article  PubMed  Google Scholar 

  30. Taoka K, Kumano K, Nakamura F, Hosoi M, Goyama S, Imai Y, et al. The effect of iron overload and chelation on erythroid differentiation. Int J Hematol. 2012;95:149–59.

    Article  CAS  PubMed  Google Scholar 

  31. Jin X, He X, Cao X, Xu P, Xing Y, Sui S, et al. Iron overload impairs normal hematopoietic stem and progenitor cells through reactive oxygen species and shortens survival in myelodysplastic syndrome mice. Haematologica. 2018;103:1627–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Zheng Q, Zhao Y, Guo J, Zhao S, Fei C, Xiao C, et al. Iron overload promotes mitochondrial fragmentation in mesenchymal stromal cells from myelodysplastic syndrome patients through activation of the AMPK/MFF/Drp1 pathway. Cell Death Dis. 2018;9:515.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Brittenham GM, Griffith PM, Nienhuis AW, McLaren CE, Young NS, Tucker EE, et al. Efficacy of deferoxamine in preventing complications of iron overload in patients with thalassemia major. N Engl J Med. 1994;331:567–73.

    Article  CAS  PubMed  Google Scholar 

  34. McLaren GD, Gordeuk VR. Hereditary hemochromatosis: insights from the Hemochromatosis and Iron Overload Screening (HEIRS) Study. Hematol Am Soc Hematol Educ Program. 2009;2009:195–206.

    Article  Google Scholar 

  35. Nielsen P, Gunther U, Durken M, Fischer R, Dullmann J. Serum ferritin iron in iron overload and liver damage: correlation to body iron stores and diagnostic relevance. J Lab Clin Med. 2000;135:413–8.

    Article  CAS  PubMed  Google Scholar 

  36. Garcia-Manero G, Shan J, Faderl S, Cortes J, Ravandi F, Borthakur G, et al. A prognostic score for patients with lower risk myelodysplastic syndrome. Leukemia. 2008;22:538–43.

    Article  CAS  PubMed  Google Scholar 

  37. Li B, Xu Z, Gale RP, Qin T, Zhang Y, Xiao Z. Serum ferritin is an independent prognostic factor in Chinese with myelodysplastic syndromes classified as IPSS Intermediate-1. Acta Haematol. 2013;129:243–50.

    Article  CAS  PubMed  Google Scholar 

  38. Park S, Sapena R, Kelaidi C, Vassilieff D, Bordessoule D, Stamatoullas A, et al. Ferritin level at diagnosis is not correlated with poorer survival in non RBC transfusion dependent lower risk de novo MDS. Leuk Res. 2011;35:1530–3.

    Article  CAS  PubMed  Google Scholar 

  39. Park S, Hamel JF, Toma A, Kelaidi C, Thepot S, Campelo MD, et al. Outcome of lower-risk patients with myelodysplastic syndromes without 5q deletion after failure of erythropoiesis-stimulating agents. J Clin Oncol. 2017;35:1591–7.

    Article  PubMed  Google Scholar 

  40. Leitch HA, Parmar A, Wells RA, Chodirker L, Zhu N, Nevill TJ, et al. Overall survival in lower IPSS risk MDS by receipt of iron chelation therapy, adjusting for patient-related factors and measuring from time of first red blood cell transfusion dependence: an MDS-CAN analysis. Br J Haematol. 2017;179:83–97.

    Article  CAS  PubMed  Google Scholar 

  41. Zipperer E, Post JG, Herkert M, Kundgen A, Fox F, Haas R, et al. Serum hepcidin measured with an improved ELISA correlates with parameters of iron metabolism in patients with myelodysplastic syndrome. Ann Hematol. 2013;92:1617–23.

    Article  CAS  PubMed  Google Scholar 

  42. Oguma S, Yoshida Y, Uchino H, Maekawa T, Nomura T, Mizoguchi H. Clinical characteristics of Japanese patients with primary myelodysplastic syndromes: a co-operative study based on 838 cases. Anemia Study Group of the Ministry of Health and Welfare. Leuk Res. 1995;19:219–25.

    Article  CAS  PubMed  Google Scholar 

  43. Germing U, Strupp C, Kuendgen A, Isa S, Knipp S, Hildebrandt B, et al. Prospective validation of the WHO proposals for the classification of myelodysplastic syndromes. Haematologica. 2006;91:1596–604.

    PubMed  Google Scholar 

  44. Komrokji RS, Corrales-Yepez M, Kharfan-Dabaja MA, Al Ali NH, Padron E, Rollison DE, et al. Hypoalbuminemia is an independent prognostic factor for overall survival in myelodysplastic syndromes. Am J Hematol. 2012;87:1006–9.

    Article  CAS  PubMed  Google Scholar 

  45. Chee CE, Steensma DP, Wu W, Hanson CA, Tefferi A. Neither serum ferritin nor the number of red blood cell transfusions affect overall survival in refractory anemia with ringed sideroblasts. Am J Hematol. 2008;83:611–3.

    Article  CAS  PubMed  Google Scholar 

  46. Roudot-Thoraval F, Halphen M, Larde D, Galliot M, Rymer JC, Galacteros F, et al. Evaluation of liver iron content by computed tomography: its value in the follow-up of treatment in patients with idiopathic hemochromatosis. Hepatology. 1983;3:974–9.

    Article  CAS  PubMed  Google Scholar 

  47. Roy NB, Myerson S, Schuh AH, Bignell P, Patel R, Wainscoat JS, et al. Cardiac iron overload in transfusion-dependent patients with myelodysplastic syndromes. Br J Haematol. 2011;154:521–4.

    Article  CAS  PubMed  Google Scholar 

  48. Feelders RA, Vreugdenhil G, Eggermont AM, Kuiper-Kramer PA, van Eijk HG, Swaak AJ. Regulation of iron metabolism in the acute-phase response: interferon gamma and tumour necrosis factor alpha induce hypoferraemia, ferritin production and a decrease in circulating transferrin receptors in cancer patients. Eur J Clin Invest. 1998;28:520–7.

    Article  CAS  PubMed  Google Scholar 

  49. Park S, Kosmider O, Maloisel F, Drenou B, Chapuis N, Lefebvre T, et al. Dyserythropoiesis evaluated by the RED score and hepcidin:ferritin ratio predicts response to erythropoietin in lower-risk myelodysplastic syndromes. Haematologica. 2019;104:497–504.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Cazzola M, Della Porta MG, Malcovati L. Clinical relevance of anemia and transfusion iron overload in myelodysplastic syndromes. Hematol Am Soc Hematol Educ Program. 2008;2008:166–75.

    Article  Google Scholar 

  51. Du Y, Long Z, Chen M, Han B, Hou B, Feng F. Observational monitoring of patients with aplastic anemia and low/intermediate-1 risk of myelodysplastic syndromes complicated with iron overload. Acta Haematol. 2017;138:119–28.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the patients, their families, all the investigators including Drs. Yukiharu Nakabo (The Center for Hematological Diseases, Takeda General Hospital), Takahiko Utsumi (Department of Hematology and Oncology, Shiga General Hospital), Tatsuo Ichinohe (Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University), Hirohiko Shibayama (Department of Hematology and Oncology, Osaka University Graduate School of Medicine), Yasuyoshi Morita (Division of Hematology and Rheumatology, Department of Internal Medicine, Kindai University Faculty of Medicine), Masayuki Shiseki (Department of Hematology, Tokyo Women’s Medical University), Masayoshi Kobune (Department of Hematology, Sapporo Medical University School of Medicine), Naoshi Obara (Department of Hematology, Graduate School of Comprehensive Human Sciences, Tsukuba University), Wataru Takahashi (Department of Hematology and Oncology, Dokkyo Medical University Hospital), and nurses in the participating institutions of this study. The authors also thank Dr. Keiya Ozawa (Institute of Medical Science, the University of Tokyo) for his mentorship; and Drs. Mizuki Watanabe, Kazue Miyamoto-Arimoto, and Tasuki Uchiyama, and Ms. Tomoko Okuda and Yukiko Takada (Department of Hematology and Oncology, Kyoto University) for their technical assistance with the construction of the database.

Funding

This work was partially supported by the Research Program of Intractable Disease provided by the Ministry of Health, Labor, and Welfare (MHLW) of Japan (H20-Nanchi-Ippan-001, H23-Nanchi-Ippan-001, H26-Nanchi-Ippan-062, H27-Nanchi-Ippan-016, H29-Nanchi-Ippan-026).

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Authors and Affiliations

  1. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Hiroshi Kawabata, Maki Shindo-Ueda, Junya Kanda & Akifumi Takaori-Kondo

  2. Department of Hematology and Immunology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa-ken, 920-0293, Japan

    Hiroshi Kawabata

  3. Department of Hematology, NTT Medical Center Tokyo, Tokyo, Japan

    Kensuke Usuki

  4. Department of Laboratory Medicine, Kawasaki Medical School, Okayama, Japan

    Kaoru Tohyama

  5. Department of Hemato-Oncology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan

    Akira Matsuda

  6. Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Saitama Medical University, Moroyama, Saitama, Japan

    Kayano Araseki

  7. Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan

    Tomoko Hata & Yasushi Miyazaki

  8. Department of Hematology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

    Takahiro Suzuki

  9. School of Medical Technology, Faculty of Health and Medical Care, Saitama Medical University, Hidaka, Saitama, Japan

    Hidekazu Kayano

  10. Clinical Laboratory Center, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan

    Kei Shimbo

  11. Department of Hematology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan

    Shigeru Chiba

  12. Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan

    Takayuki Ishikawa

  13. Department of Hematology, Medical Research Institute Kitano Hospital, Osaka, Japan

    Nobuyoshi Arima

  14. Department of Hematology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan

    Masaharu Nohgawa

  15. Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Mineo Kurokawa

  16. Department of Hematology, Tokyo Metropolitan Police Hospital, Tokyo, Japan

    Shunya Arai

  17. Department of Hematology and Oncology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan

    Kinuko Mitani

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  1. Hiroshi Kawabata
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Dr. Kawabata reports personal fees from Nippon Shinyaku Co., Ltd. outside the submitted work. Dr. Tohyama reports personal fees from Celgene Corporation and SymBio Pharmaceuticals Ltd. outside the submitted work. Dr. Matsuda reports personal fees from Kyowa Hakko Kirin Co., Ltd., Nippon Shinyaku Co., Ltd., GlaxoSmithKline K. K., Celgene Corporation, Alexion Pharmaceuticals, Inc., Sanofi K. K., Beckman Coulter K. K., and Shire Japan K.K.; grants and personal fees from Sumitomo Dainippon Pharma Co., Ltd., Chugai Pharmaceutical Co., Ltd., and Novartis Pharma K. K.; and grants from Astellas Pharm Inc., Asahi Kasei Pharma Co., Ltd., Eisai Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Boehringer Ingelheim Japan Inc., MSD K. K., Daiichi Sankyo Co., Ltd., Abbvie GK, and HUYA Bioscience International outside the submitted work. Dr. Suzuki reports personal fees from Novartis Pharma K.K., Nippon Shinyaku Co., Ltd., Celgene Corporation, and Kyowa Hakko Kirin Co., Ltd.; grants from Astellas Pharma Inc. outside the submitted work. Mr. Shimbo reports personal fees from Celgene Corporation, and Bristol-Myers Squibb outside the submitted work. Dr. Chiba reports grants from Kyowa Hakko Kirin Co., Ltd., Bristol-Myers Squibb, and Astellas Pharma Inc. outside the submitted work. Dr. Miyazaki reports personal fees from Novartis Pharma K.K., Dainippon Sumitomo Pharma Co., Ltd., Celgene Corporation, and SymBio Pharmaceuticals Ltd.; personal fees and grants from Kyowa Hakko Kirin Co., Ltd.; grants from Chugai Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Pfizer Seiyaku K.K. outside the submitted work. Dr. Mitani reports grants and personal fees from Kyowa-Hakko Kirin Co., Ltd.; and grants from Chugai Pharmaceutical Co., Ltd., Novartis Pharma K.K., Teijin Pharma Ltd., Japan Blood Products Organization, Ono Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Toyama Chemical Co., Ltd. outside the submitted work. Dr. Kurokawa reports personal fees from Shionogi & Co., Ltd. and Celgene Corporation; grants from Kyowa Hakko Kirin Co., Ltd., Nippon Shinyaku Co., Ltd., Astellas Pharma Inc., Ono Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Novartis Pharma K.K., Bristol-Myers Squibb, and Pfizer Seiyaku K.K. outside the submitted work. Dr. Takaori-Kondo reports personal fees from Yanssen Pharmaceutical K.K., Novartis Pharma K.K., and Bristol-Myers Squibb; personal fees and grants from Pfizer Seiyaku K.K. and Celgene Corporation; and grants from Chugai Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Astellas Pharma Inc., Japan Blood Products Organization, Eisai Co., Ltd., Shionogi & Co., Ltd., Mochida Pharmaceutical Co., Ltd., and Otsuka Pharmaceutical Co., Ltd. outside the submitted work.

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Kawabata, H., Usuki, K., Shindo-Ueda, M. et al. Serum ferritin levels at diagnosis predict prognosis in patients with low blast count myelodysplastic syndromes. Int J Hematol 110, 533–542 (2019). https://doi.org/10.1007/s12185-019-02710-1

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