Associations and prognostic interactions between circulating levels of hepcidin, ferritin and inflammatory cytokines in primary myelofibrosis

Animesh Pardanani, Christy Finke, Ramy A. Abdelrahman, Terra L. Lasho, Ayalew Tefferi

Research output: Contribution to journalArticlepeer-review

40 Scopus citations

Abstract

Iron homeostasis is dysregulated in primary myelofibrosis (PMF), given the high prevalence of anemia, need for red blood cell (RBC) transfusions, and disease-associated inflammatory state. We measured plasma hepcidin levels in 203 consecutive PMF patients at the time of first referral; hepcidin levels were significantly higher as compared to healthy controls (P<0.0001), and were correlated with hemoglobin of <10 g/dL, RBC transfusion requirement, serum ferritin of >500 μg/L, higher dynamic international prognostic scoring system (DIPSS)-plus risk category, the presence of circulating blasts, age of >65 years, and leukocyte count of <4 × 109/L. Increased hepcidin levels predicted for inferior survival independent of six out of the eight DIPSS-plus prognostic parameters (hazard ratio [HR]=1.8; P=0.02), but not when RBC transfusion requirement, hemoglobin of <10 g/dL, or increased serum ferritin were included in the Cox model. Multivariable analysis that considered the four overlapping prognostic variables revealed that increased hepcidin (HR=1.9; P=0.03) and increased ferritin (HR=2.3; P=0.04), but not hemoglobin of <10 g/dL or RBC transfusion requirement, independently retained their significance for predicting survival. Accordingly, increased levels of both hepcidin and serum ferritin (seen in 29% of patients) predicted inferior survival independent of DIPSS-plus or increased inflammatory cytokine levels (HR=2.4; P=0.002), and could be considered in future prognostic models for PMF.

Original languageEnglish (US)
Pages (from-to)312-316
Number of pages5
JournalAmerican journal of hematology
Volume88
Issue number4
DOIs
StatePublished - Apr 2013

ASJC Scopus subject areas

  • Hematology

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