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Original Research Myelodysplastic Syndrome Transient Elastography for the Detection of Hepatic Iron Overload in Patients with Myelodysplastic Syndrome Malene Risum, 1 Toke Barfod 2 and Klas Raaschou-Jensen 1 1. Department of Hematology, University Hospital of Copenhagen, Roskilde, Denmark; 2. Department of Infectious Medicine, University Hospital of Copenhagen, Roskilde, Denmark B ackground: In myelodysplastic syndrome (MDS), anemia often leads to red blood cell transfusion dependency and iron overload (IOL). Serum ferritin (SF) is used as a surrogate marker for IOL. IOL can lead to liver failure. Transient elastography (TE) also known as fibroscan is an easy and noninvasive procedure for liver stiffness measurements (LSM). Methods: Sixty patients with either MDS, chronic myelomonocytic leukemia with dysplastic features, acute myeloid leukemia progressed from MDS or myelodysplastic/ myeloproliferative neoplasm, unclassifiable were included. All patients underwent a fibroscan, had their SF measured and disease duration calculated. Patients were grouped according to transfusion dependency or independency status. Results: Transfusion dependent patients had significantly higher LSM than those who were transfusion independent (p=0.003). There was no positive correlation between SF and LSM (p=0.103) or time since diagnosis and LSM (p=0.886). Patients with elevated SF did not have significantly higher LSM compared to those with normal SF (p=0.583). Conclusion: These data indicate that transfusion dependency has an impact on liver stiffness in MDS. Longitudinel studies are needed to conclude whether TE is of value in monitoring IOL in MDS. Keywords Myelodysplastic syndrome, iron overload, transfusion, liver, fibroscan Disclosure: No research funding was received for this study. Malene Risum received travel expenses from Novartis to present the provisional results of the study at The 13th international symposium on myelodysplastic syndromes April 29th - May 2nd, 2015. Toke Barfod and Klas Raaschou-Jensen have nothing to disclose in relation to this article. No funding was received in the publication of this article. Acknowledgements: Christian Alexander Möller and Roberto Oliveri for helping perform the statistics with R statistics and SPSS respectively. Compliance with Ethics: All procedures were followed in accordance with the responsible committee on human experimentation and with the Helsinki Declaration of 1975 and subsequent revisions, and informed consent was received from the patient involved in this study. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 3 July 2016 Accepted: 11 August 2016 Citation: European Oncology & Haematology, 2016;12(2):103–6 Corresponding Author: Malene Risum, Department of Hematology, University Hospital of Copenhagen, Roskilde, Denmark. E: malene.risum@gmail.com In myelodysplastic syndrome (MDS), iron overload (IOL) is the result of multiple red blood cell (RBC) transfusions and increased iron absorption. The cause for the latter is low hepcidin levels due to an ineffective erythropoiesis. 1 Increased iron absorption contributes to IOL, but chronic RBC transfusions are considered the main cause of IOL. 2 IOL can lead to liver fibrosis, cirrhosis and heart failure. Patients with MDS are often elderly people with pre-existing co-morbidities which can worsen the clinical symptoms of anaemia and lead to the need of RBC transfusions. Cardiac failure and liver failure have been reported in 24% and 6.7% of patients, respectively; most likely as the result of heavy transfusion dependency. 3 Serum ferritin (SF) works as a surrogate marker for IOL in MDS. It is usually recommended to start iron chelation when the patient has had 20–25 units of RBC transfusions, and SF exceeds 1,000 µg/l in patients with lower risk MDS. 2 SF can be affected by other conditions such as infection and cancer. To determine the stage of liver fibrosis or liver iron content a liver biopsy or magnetic resonance imaging (MRI) T2* is required. Both procedures are time-consuming, but due to the risk of bleeding, a liver biopsy is almost never performed on MDS patients. 4 Transient elastography (TE), also known as FibroScan ® (Echosens, Paris, France), is a noninvasive method which measures the stiffness of the liver as a surrogate for liver fibrosis. Liver stiffness is determined by the velocity of a shear wave sent through the liver using a probe. Liver stiffness measurements (LSM) are expressed in kilopascal (kPa); the higher the value the stiffer tissue. 5 A normal value is approximately 5 kPa. 5 TE has no side-effects or complications and is easy to perform. TE has a high reproducibility with a high inter- and intra-observer agreement. 6 The failure rate of TE has been reported to 2.4–9.4%. 7 The cause of failure is often obesity. 7 Conditions with inflammation, extrahepatic cholestasis and congestion can also affect the result since these conditions can constitute space-occupying difficulties and interfere with LSM. 5 TE originates from studies on liver fibrosis in patients with hepatitis C virus (HCV) 8 and hepatitis B virus (HBV) infection, 9 and has been extensively investigated in patients with HCV infection. In HCV and HBV, fibrosis is considered either absent or mild when values are ≤7 kPa. 5 In haematology, TE for the detection of liver fibrosis has been investigated in patients with IOL caused by different diseases 10,11 and in thalassemia 12–18 and haemochromatosis exclusively. 19,20 TE has also been investigated in patients undergoing stem cell transplantation (SCT) with the aim of detecting complications affecting the liver in connection to SCT. 21,22 TOU CH MED ICA L MEDIA 103