Serum ferritin as a prognostic biomarker in CAR-T therapy for multiple myeloma: A meta-analysis

Serum ferritin, a marker of systemic inflammation and iron metabolism, has been implicated in the outcomes of patients with relapsed/refractory multiple myeloma (R/R MM). However, its prognostic significance in R/R MM patients undergoing chimeric antigen receptor-modified T-cell (CAR-T) therapy rem...

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Main Authors: Jing Cheng, Yuan Song
Format: Article
Language:English
Published: Association of Basic Medical Sciences of Federation of Bosnia and Herzegovina 2025-03-01
Series:Biomolecules & Biomedicine
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Online Access:http://www.bjbms.org/ojs/index.php/bjbms/article/view/12129
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author Jing Cheng
Yuan Song
author_facet Jing Cheng
Yuan Song
author_sort Jing Cheng
collection DOAJ
description Serum ferritin, a marker of systemic inflammation and iron metabolism, has been implicated in the outcomes of patients with relapsed/refractory multiple myeloma (R/R MM). However, its prognostic significance in R/R MM patients undergoing chimeric antigen receptor-modified T-cell (CAR-T) therapy remains unclear. This meta-analysis aimed to evaluate the association between pre-infusion serum ferritin levels and survival outcomes in R/R MM patients treated with CAR-T therapy. We systematically searched PubMed, Embase, and Web of Science for relevant studies. Studies reporting progression-free survival (PFS) and/or overall survival (OS) based on serum ferritin levels were included. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Eight retrospective cohort studies, encompassing 1,077 patients, met the inclusion criteria. High pre-infusion serum ferritin levels were significantly associated with worse PFS (HR: 2.15, 95% CI: 1.74–2.66, p < 0.001) and OS (HR: 2.86, 95% CI: 2.20–3.72, p < 0.001), with mild heterogeneity (I² = 9% for PFS and 0% for OS). Sensitivity analyses, conducted by excluding one study at a time, confirmed the robustness of these findings. Subgroup analyses showed consistent results across different CAR-T product sources (commercial vs. academic), ferritin cutoffs, and follow-up durations (p for subgroup differences all > 0.05). In conclusion, elevated serum ferritin levels before CAR-T infusion predict poorer survival outcomes in R/R MM patients. These findings highlight the potential prognostic value of ferritin and its role in optimizing patient selection and management strategies in CAR-T therapy.
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spelling doaj-art-2c34ac8789dd4bcd8e19172d6bcdbc0f2025-08-20T01:53:16ZengAssociation of Basic Medical Sciences of Federation of Bosnia and HerzegovinaBiomolecules & Biomedicine2831-08962831-090X2025-03-0110.17305/bb.2025.12129Serum ferritin as a prognostic biomarker in CAR-T therapy for multiple myeloma: A meta-analysisJing Cheng0Yuan Song1Department of Hematology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Donghu District, Nanchang City, Jiangxi Province, ChinaDepartment of Hematology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Donghu District, Nanchang City, Jiangxi Province, China Serum ferritin, a marker of systemic inflammation and iron metabolism, has been implicated in the outcomes of patients with relapsed/refractory multiple myeloma (R/R MM). However, its prognostic significance in R/R MM patients undergoing chimeric antigen receptor-modified T-cell (CAR-T) therapy remains unclear. This meta-analysis aimed to evaluate the association between pre-infusion serum ferritin levels and survival outcomes in R/R MM patients treated with CAR-T therapy. We systematically searched PubMed, Embase, and Web of Science for relevant studies. Studies reporting progression-free survival (PFS) and/or overall survival (OS) based on serum ferritin levels were included. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Eight retrospective cohort studies, encompassing 1,077 patients, met the inclusion criteria. High pre-infusion serum ferritin levels were significantly associated with worse PFS (HR: 2.15, 95% CI: 1.74–2.66, p < 0.001) and OS (HR: 2.86, 95% CI: 2.20–3.72, p < 0.001), with mild heterogeneity (I² = 9% for PFS and 0% for OS). Sensitivity analyses, conducted by excluding one study at a time, confirmed the robustness of these findings. Subgroup analyses showed consistent results across different CAR-T product sources (commercial vs. academic), ferritin cutoffs, and follow-up durations (p for subgroup differences all > 0.05). In conclusion, elevated serum ferritin levels before CAR-T infusion predict poorer survival outcomes in R/R MM patients. These findings highlight the potential prognostic value of ferritin and its role in optimizing patient selection and management strategies in CAR-T therapy. http://www.bjbms.org/ojs/index.php/bjbms/article/view/12129Multiple myelomachimeric antigen receptor-modified T cellsCAR-Tferritinsurvivalprogression
spellingShingle Jing Cheng
Yuan Song
Serum ferritin as a prognostic biomarker in CAR-T therapy for multiple myeloma: A meta-analysis
Biomolecules & Biomedicine
Multiple myeloma
chimeric antigen receptor-modified T cells
CAR-T
ferritin
survival
progression
title Serum ferritin as a prognostic biomarker in CAR-T therapy for multiple myeloma: A meta-analysis
title_full Serum ferritin as a prognostic biomarker in CAR-T therapy for multiple myeloma: A meta-analysis
title_fullStr Serum ferritin as a prognostic biomarker in CAR-T therapy for multiple myeloma: A meta-analysis
title_full_unstemmed Serum ferritin as a prognostic biomarker in CAR-T therapy for multiple myeloma: A meta-analysis
title_short Serum ferritin as a prognostic biomarker in CAR-T therapy for multiple myeloma: A meta-analysis
title_sort serum ferritin as a prognostic biomarker in car t therapy for multiple myeloma a meta analysis
topic Multiple myeloma
chimeric antigen receptor-modified T cells
CAR-T
ferritin
survival
progression
url http://www.bjbms.org/ojs/index.php/bjbms/article/view/12129
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