Hyperfibrinogenemia as a Poor Prognostic Indicator in Myelodysplastic Syndrome

Cong Shi,1,&ast; Shengping Gong,2,&ast; An Wu,3 Tingting Niu,1 Ningning Wu,1 Yi Zhang,1 Guifang Ouyang,3 Qitian Mu1 1Laboratory of Stem Cell Transplantation, Ningbo First Hospital, Ningbo, Zhejiang, People’s Republic of China; 2Cancer Radiotherapy and Chemotherapy Center, Ningbo First Hospital, Ningbo, Zhejiang, People’s Republic of China; 3Hematology Department, Ningbo First Hospital, Ningbo, Zhejiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guifang Ouyang; Qitian Mu, Email nbhematology@163.com; muqitian@163.comBackground: Myelodysplastic syndrome (MDS) is a group of heterogeneous myeloid clonal diseases originating from hematopoietic stem cells. It has been demonstrated that fibrinogen (FIB) is associated with disease risk in several cancer types. Coagulation and fibrinolysis problems are widespread in MDS patients. Therefore, FIB might be one of these indicators. We thus examined the role of FIB levels in the prognosis of MDS.Methods: A cohort of 198 MDS patients were retrospectively analyzed to explore the prognostic value of the plasma FIB levels at diagnosis. Patients were divided into the high FIB group and low FIB group. The prognostic significance of FIB was determined by univariate and multivariate Cox hazard models.Results: In our cohort, the FIB levels in 198 MDS patients were higher than those in 100 healthy donors (3.9 g/L vs 2.9 g/L, P < 0.0001). MDS patients with high FIB levels had significantly shorter overall survival (OS; P = 0.001) and decreased leukemia-free survival (LFS; P = 0.036). Multivariate cox proportional hazards regression analysis indicated that, in addition to older age, gender, lower HB, poorer karyotype for OS, lower NE, and higher bone marrow blast percentage for OS and LFS, elevated FIB level was also an independent adverse prognostic factor for OS (P = 0.045) but not for LFS (P = 0.188).Conclusion: Elevated FIB levels may be associated with mortality risk among MDS patients and could predict disease progress and patient prognosis. Thus, assessment of FIB levels may promote the determination of the prognosis of MDS patients.Keywords: myelodysplastic syndrome, IPSS-R, prognostic, overall survival, fibrinogen