In a recent study, the Fibrinogen-Albumin Ratio Index (FARI) was demonstrated to have prognostic value in patients treated with azacitidine (AZA) for myelodysplastic syndrome (MDS) or acute myeloid leukemia with myelodysplasia-related changes (AML-MRC). The study results were published in the Annals of Hematology.

Increased plasma fibrinogen is associated with inflammation, while lower albumin levels can be seen in the setting of inflammation, according to the study investigators. The FARI has shown value as a prognostic score related to inflammation with certain cancers, but knowledge about its possible role as a prognostic indicator for patients with MDS or AML-MRC has been limited, the researchers explained.

The single-center study was a retrospective analysis of a cohort of 99 patients who had MDS or AML-MRC and received treatment with AZA. FARI was calculated as the plasma fibrinogen level divided by plasma albumin level.

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Optimal thresholds for grouping patients by FARI or other factors were determined through receiver operating characteristic (ROC) curve analysis. The researchers evaluated relationships between FARI, other prognostic factors, and outcomes, and 1-year overall survival (OS) was the primary study endpoint.

Patients had a median of 5 cycles of AZA and a median age of 74 years. ROC curve analysis determined an optimal FARI score was 0.079 in predicting OS at 1 year. The area under the curve in this analysis was 0.692 (95% CI, 0.588-0.796).

Patients were grouped according to FARI values, with a high-FARI group having a FARI at or above the optimal threshold of 0.079, and a low-FARI group having FARI values below this threshold. The high-FARI group represented 60% of the study population, and the low-FARI group represented 40%.

The researchers found a significant difference in 1-year OS rates between groups stratified by FARI, with a rate of 35.6% for the high-FARI group and 77.5% for the low-FARI group (P <.001).

A multivariate analysis showed that a FARI above 0.079 or more was an independent predictor of worse OS (hazard ratio [HR], 2.41 [95% CI, 1.36-4.29]; P =.006). A very high score using the Revised-International Prognostic Scoring System was also an independent predictor of worse OS (HR, 1.483 [95% CI, 1.12-1.963]; P =.006).

“To our knowledge, this is the first study to show that the FARI is an independent prognostic factor for the OS in MDS and AML-MRC patients treated with AZA,” the researchers reported.


Akimoto M, Sakurai A, Nishiyama-Fujita Y, Ito C, Aisa Y, Nakazato T. The prognostic value of the Fibrinogen-Albumin Ratio Index in patients with myelodysplastic syndrome and acute myeloid leukemia with myelodysplasia-related changes treated with azacitidine. Ann Hematol. Published online February 1, 2021. doi:10.1007/s00277-021-04440-z