Hyperferritinemia at diagnosis predicts relapse and overall survival in younger AML patients with intermediate-risk cytogenetics

• Two-third of de novo AML patients have elevated levels of serum ferritin at diagnosis.
• Hyperferritinemia is associated with high WBC, higher CRP levels and NPM1 mutation.
• Hyperferritinemia is associated with a high risk of relapse after chemotherapy.
• Hyperferritinemia has a negative prognostic impact in intermediate cytogenetic group.

The prognostic value of ferritin level at diagnosis in AML patients is unknown. We studied 162 younger AML patients with intermediate-risk cytogenetics who received intensive chemotherapy. The median ferritin level at diagnosis was 633 μg/L and 128 (79%) patients had a ferritin level above the upper normal limit. Hyperferritinemia was significantly associated with a higher cumulative incidence of relapse as well as poorer disease-free and overall survival. In multivariate analysis, hyperferritinemia remained an independent poor prognosis factor. The level of ferritin at diagnosis has a major impact on relapse suggesting a link between inflammation, oxidative stress and chemoresistance in AML.