Transfusion-associated iron overload may lead to increased risk of infection, but its role in myelofibrosis (MF) has been scarcely explored. We evaluated 106 consecutive patients with primary or secondary MF. Up to 38% of patients were transfusion-dependent (TD) with a median of 14 RBC units received. Median observation time was 36 months (range 3-203). Forty-five percent of patients experienced one or more infectious episodes for a total of 69 infectious events, 13 (19%) of which were severe. The 60-month cumulative incidence of infection was 64.1 ± 6.5%. TD patients showed a higher incidence of infection (HR = 2.13, p = 0.019). Transfusion burden was markedly greater in TD patients with infectious complication (median 24 RBC units vs 15 RBC units; p = 0.012). The 60-month overall survival was 40 ± 5.9%. Lower International Prognostic Scoring System (IPSS) risk (p < 0.0001) and ruxolitinib (p = 0.027) were significantly correlated with higher survival. This real-world study showed increased infections in patients with higher transfusion burden. It may therefore be interesting to further investigate the role of iron chelation in improving infection-free survival in MF patients.

中文翻译：

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在临床环境中，骨髓纤维化和输血相关铁过载患者的感染发生率增加。

输血相关的铁超负荷可能会导致感染风险增加，但其在骨髓纤维化 (MF) 中的作用却鲜有研究。我们评估了 106 名连续患有原发性或继发性 MF 的患者。高达 38% 的患者为输血依赖 (TD)，平均接受了 14 个 RBC 单位。中位观察时间为 36 个月（范围 3-203）。45% 的患者经历了一次或多次感染事件，共发生 69 起感染事件，其中 13 起 (19%) 是严重的。60 个月累积感染发生率为 64.1 ± 6.5%。TD 患者的感染发生率更高（HR = 2.13，p = 0.019）。患有感染性并发症的 TD 患者的输血负担明显更大（中位数 24 RBC 单位 vs 15 RBC 单位；p = 0.012）。60 个月的总生存率为 40 ± 5.9%。较低的国际预后评分系统 (IPSS) 风险 (p < 0.0001) 和鲁索替尼 (p = 0.027) 与较高的生存率显着相关。这项真实世界的研究表明，输血负担较高的患者感染增加。因此，进一步研究铁螯合在改善 MF 患者无感染生存期中的作用可能很有趣。