OBJECTIVES : Most patients with myelodysplastic syndromes (MDS) will require red blood cell transfusions during the course of the disease, which may cause iron overload. A systematic literature review (SLR) was undertaken to evaluate evidence on the relationship between serum ferritin (SF) levels and outcomes in these patients.

METHODS : Systematic searches were conducted in MEDLINE and Embase for studies published from 2009 to April 23, 2020, along with conferences of interest from the last 2 years. Studies assessing the association between SF levels and clinical outcomes, health-related quality of life (HRQoL), or economic outcomes in adult patients with MDS were identified.

RESULTS : Of 267 citations retrieved, 61 were screened at the full-text level, and 21 were included. No data on SF and its relationship with HRQoL or economic outcomes were identified. Higher SF was an indicator of worse survival outcomes, though data were limited. Thirteen studies reported that increased SF was an indicator of worse overall survival, with higher SF significantly associated with worse outcomes; however, the association was not significant in 5 studies. SF level was a significant prognostic factor for relapse of MDS and had a significant positive correlation with number of blood units transfused. Higher SF was an indicator of a lower likelihood of event-free, relapse-free, or leukemia-free survival in 6 studies, of which 5 found a significant association. Two studies reported that SF was not associated with progression to acute myeloid leukemia, or with the time to transformation in those who did progress. SF > 1,000 ng/mL before and during hemopoietic stem cell transplantation was reported as a significant prognostic factor for MDS relapse in 2 studies.

CONCLUSIONS : Studies suggest SF levels are associated with clinical outcomes in MDS, with higher levels frequently indicating worse outcomes.