Determining the frequency of iron overload at diagnosis in de novo acute myeloid leukemia patients with multilineage dysplasia or myelodysplasia-related changes: a case control study

Acute myeloid leukemia (AML) with myelodysplasia-related changes (AML-MRC) is a new disease category, which was defined as a separate entity in the World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues. While pre-treatment iron overload in patients with myelodysplastic syndrome has been previously studied, its relationship with AML-MRC has not been studied. We aimed to investigate the relationship between serum iron tests compatible with iron overload and the diagnosis of multilineage dysplasia (MLD) and AML with myelodysplasia-related changes (AML-MRC) in AML patients diagnosed at Hacettepe University Adult Hospital between January 2002 and September 2017. Ninety-three patients who met the criteria were enrolled. Bone marrow aspirate of each patient was re-examined, and dysplasia was investigated; other data were examined from patient’s records. The iron overload status at diagnosis and transferrin saturation (TS) values were compared between the groups with and without MLD and those with and without AML-MRC. When iron overload was defined as TS ≥ 58% and ferritin ≥ 500 ng/mL, iron overload was observed in 10 (37%) patients with MLD and in 4 (13%) without MLD. The difference is almost statistically significant (p = 0.053). The mean TS value and frequency of iron overload were higher in AML-MRC patients than in non-AML-MRC patients (p < 0.05 for both). A mild positive significant correlation was observed between the dysplasia severity score and TS (r = 0.317, p = 0.032). In patients with AML-MLD and AML-MRC, iron overload occurred regardless of the transfusion status at the time of diagnosis. Morphologic severity of dysplasia may be correlated with higher TS values at the time of diagnosis.