Prognostic significance of baseline serum ferritin in newly diagnosed multiple myeloma cases: A retrospective study from southern India

Background & objectives Ferritin levels, crucial for iron homeostasis, may hold prognostic significance in multiple myeloma (MM) due to their responsiveness to inflammation. The objective of this study was to evaluate the prognostic significance of baseline serum ferritin levels in predicting progression-free survival (PFS) and overall survival (OS) in newly diagnosed south Indian patients with multiple myeloma. Methods We retrospectively analysed records of 152 newly diagnosed multiple myeloma (NDMM) patients, grouping them by ferritin levels: group 1 with low ferritin (LF) (<300 ng/ml, n=68) and group 2 with high ferritin (HF) (≥300 ng/ml, n=84). Cox Proportional Hazard Models were used to identify prognostic risk factors for PFS and OS. Results NDMM patients with elevated diagnostic ferritin levels exhibited significantly higher levels of creatinine (P=<0.0001), lactate dehydrogenase (LDH, P=0.005), C-reactive protein (CRP, P=0.02), erythrocyte sedimentation rate (ESR, P=0.04), rate of disease progression (P=0.002), and death (P=0.011), along with a notable decrease in albumin (P=<0.0001) and haemoglobin (P=0.04) compared to MM patients with low ferritin levels. Time-to-event analysis revealed shorter PFS (P=0.0053) and OS (P=0.014) in the HF group. Elevated ferritin independently predicted progression [HR=2.59, 95% confidence interval (CI): 1.29-5.16, P=0.006] and was associated with increased mortality risk (HR=2.93, 95% CI: 1.19-7.24, P=0.02). Hazard ratios for progression and mortality increased with an increase in ferritin levels. Ferritin showed a weak positive correlation with plasma cell per cent (r=0.122, 95% CI: -0.07-0.31). Ferritin also provided better prediction (25.8 and 32.4%) of PFS and OS than CRP (14.7 and 15.8%). Interpretation & conclusions High ferritin levels in multiple myeloma are linked to worse prognosis and poor outcomes, highlighting the need for further research to validate and expand these findings.