Prognostic Value of Serum Erythropoietin Level,Ferritin Level and Fibrinogen in Adult Low Risk MDS

The myelodysplastic syndromes (MDSs) are clonal hematopoietic stem cell disorders characterized by progressive peripheral cytopenia due to ineffective hematopoiesis and a variable risk of transformation into acute myeloid leukemia (AML) .

Clinically, they can range from variable grade of cytopenia to forms not different from AML.

World Health Organization (WHO) MDS classifications from 2002:

included refractory anemia (RA), refractory anemia with ring sideroblasts (RARS), refractory cytopenia with multilineage dysplasia (RCMD), RCMD and ring sideroblasts (RCMDRS), refractory anemia with excess blasts (RAEB), and MDS associated with isolated del(5q) The most recent 2016 WHO MDS classifications are slightly different and include MDS with single lineage or multilineage dysplasia, MDS with ring sideroblasts and single or multilineage dysplasia, MDS with excess blasts, and MDS with isolated del(5q) .

A key first-line treatment option for many patients with symptomatic anemia associated with lower-risk MDS is erythropoiesis-stimulating agents (ESAs) (e.g., epoetin alpha ordarbepoetinalpha),whichmayalsobecombinedwithgranulocyte colony-stimulating factor (G-CSF At least, four mechanisms are recognized to underlie pancytopenia in myelodysplastic syndromes. Based on ferrokinetic studies two distinct mechanisms can be distinguished: (1) hypoproliferative suppressed erythropoiesis and (2) hypoproliferative/ineffective erythropoiesis,The predictive variables for ESAs response in MDS should be divided into biological and clinical variables. Biological variables include: endogenous erythropoietin levels < 500 U/L and marrow blasts < 10%, IPSS low INT-1, diagnosis of refractory anemia, and normal karyotype. On clinical plane, transfusion independence and short duration of disease are positive prognostic factors of response to ESAS .