High fibrinogen levels were associated with poorer outcomes, including shorter survival, among patients with myelodysplastic syndrome (MDS), according to the results of a study published in the journal Cancer Management and Research.
Previous studies suggested that fibrinogen level may be associated with poor prognosis for some tumor types. Given that fibrinolysis is a common issue among patients with MDS, the aim of this study was to evaluate the relationship between fibrinogen levels and MDS prognosis.
The retrospective study evaluated data from 198 patients diagnosed with MDS between 2009 and 2019 at a single center in China. The cohort was categorized as either high or low fibrinogen. All patients were symptomatic and provided supportive treatment, with some patients also receiving intensive chemotherapy with hematopoietic stem cell transplant or hypomethylating agents. Blood specimens were also analyzed from 100 healthy donors who had not been hospitalized within the last 6 months and had no history of vascular disease, thrombosis, or hemorrhage.
The cohort had a median age of 62 with a median duration of follow-up of 16 months. Of patients who were stratified by IPSS-R group, 5.3% were very low risk, 20.1% low risk, 32.0% intermediate risk, 20.7% high risk, and 21.9% were very high risk. There were 14.6% of patients who progressed to acute myeloid leukemia.
Among the entire cohort, fibrinogen levels were significantly higher than the healthy controls (P <.0001).
There were 68.5% of patients who had mutations within 16 genes that were evaluated. Higher fibrinogen level was associated with more frequent gene mutations, with mutations most commonly affecting ASXL1, TP53, RUNX1, SF3B1, and TET2.
Patients with MDS with high fibrinogen levels, defined as >3.6 g/L, demonstrated a significantly shorter overall survival time compared with patients with low fibrinogen levels, with a median of 19 or 81 months, respectively (P =.001). Leukemia-free survival (LFS) was also shorter among patients with high fibrinogen levels (P =.036).
High fibrinogen levels were demonstrated to be an independent prognostic factor for OS (P =.045), but not LFS (P =.188), according to multivariate analyses. Other independent prognostic factors for OS included age, gender, karyotype, bone marrow blast percentage, among others. The only prognostic factor for LFS was bone marrow blasts.
The authors concluded that “elevated fibrinogen may be associated with mortality risk among MDS patients and could predict disease progress and patient prognosis.”
Shi C, Gong S, Wu A, et al. Hyperfibrinogenemia as a poor prognostic indicator in myelodysplastic syndrome. Cancer Manag Res. 2022;14:1857-1865. doi: 10.2147/CMAR.S363568