Clinical features and outcomes of myelodysplastic syndrome patients with iron overload: a single-center retrospective study

Objectives Most of the myelodysplastic syndromes (MDS) patients suffer from iron overload (IOL) due to ineffective hematopoiesis and repeated blood transfusions. IOL may affect the survival of MDS patients, but the related mechanism has not been fully clarified. We aimed to provide clinical evidence for the impact of IOL on the immunity and prognosis of MDS patients. Methods The clinical features and outcomes of 144 patients with MDS between March 2019 and December 2023 were analyzed. Patients were classified into the IOL group (ferritin > 1000 ng/mL) and the non-iron overload (NIOL) group (ferritin <= 1000 ng/mL). Results The median age of the patients was 64 (22-89) years, and IOL MDS patients had a poorer performance status. IOL MDS patients had significantly higher alanine aminotransferase and blood glucose levels. White blood cell counts and hemoglobin levels were significantly lower in IOL MDS patients. Meanwhile, the proportion of erythrocyte and megakaryocyte counts were significantly decreased in MDS patients with IOL. The incidence of 7q- chromosome abnormalities in IOL group was significantly higher. The level of Interleukin-6 was markedly elevated in patients with IOL MDS, accompanied by significant abnormalities in dendritic cells. Survival analysis indicated that IOL MDS patients had a shorter survival duration. Age >= 60 years, ferritin > 1000 ng/mL, complex chromosomal abnormalities, and gene mutations in TP53 and RUNX1 were independent adverse prognostic factors for MDS patients. Conclusions IOL MDS patients exhibit poorer performance status and organ function, with hematopoietic and immune function abnormalities potentially affecting their survival.