PB1808 THE LEVELS OF SERUM FERRITIN CAN BE A PREDICTIVE FACTOR FOR SURVIVAL OUTCOMES IN DIFFUSE LARGE B CELL LYMPHOMA PATIENTS WITH ANEMIA

Abstract

Background:There are many clinical and molecular factors used to predict outcomes in patients with malignant lymphomas. Some studies have shown that serum ferritin levels correlated with tumor mass and closely followed disease activity in patients with hematologic malignancies such as malignant lymphoma and acute leukemia. And serum ferritin has frequently been used as a surrogate marker for systemic iron stores, but may also be elevated in specific circumstances without excess iron stores, such as in inflammation. Nevertheless, in actual clinical practice, the patients with malignant lymphoma, who are anemic and have high serum ferritin levels, are considered to suffer from anemia of chronic disease (ACD). To date, no studies have reported the survival differences between the ferritin and Hemoglobin (Hb) levels.Aims:Therefore, we investigated the clinical significance of high serum ferritin level in DLBCL patients with ACD.Methods:A total of 312 patients who were diagnosed with DLBCL between 2010 and 2016 were retrospectively analyzed. Patients were divided into four groups based on their ferritin (<500 and ≥500 ng/ml) and hemoglobin (Hb, <12 and ≥12 g/dL) levels. Progression free survival and Overall survival were calculated with the use of the Kaplan‐Meier methods.Results:In this study, several factors were demonstrated as independent prognostic factors for survival outcomes. IPI risk is an independent prognostic factor for the 5‐year PFS and 5‐year OS (relative risks (RR) = 0.458, 95% confidence interval [CI]: 0.277–0.758, p = 0.002 and RR = 0.297, 95% CI: 0.152–0.578, p < 0.001, respectively). Non‐bulky mass (<10 cm) (RR = 1.995, 95% CI: 1.140–3.448, p = 0.015) and female sex (RR = 1.848, 95% CI: 1.141–2.997, p = 0.013) were independent good prognostic factors for the 5‐year PFS. Low Hb and high ferritin were also independent poor prognostic factor for the 5‐year PFS (RR = 2.411, 95% CI: 1.063–5.473, p = 0.035: compared with high Hb and low ferritin levels and RR = 2.124, 95% CI: 1.072–4.209, p = 0.031: low Hb and low ferritin). Nevertheless, the groups based on Hb and ferritin levels did not significantly differ for 5‐year OS. In addition, the survival outcomes based on the ferritin level in patients with anemia (Hb < 12.0 g/dL) indicated statistically significant difference. The 5‐year PFS values were 59.3% and 40.9% in low and high serum ferritin levels (<500 and ≥500 ng/ml), respectively (p = 0.01), and the 5‐year OS values were 78.4% and 51.9% in the low and high ferritin levels, respectively (p = 0.006).Summary/Conclusion:High serum ferritin levels may prove to be efficient predictive markers for survival outcomes in DLBCL patients with anemia looks like ACD. In DLBCL patients with anemia, that is, considered as ACD, high ferritin level may not indicate a simple ACD but may be a prognostic factor for poor survival.