Monosomal karyotype in MDS: explaining the poor prognosis?

• DOI: 10.1038/leu.2013.187
• Publication Date: 2013-06-21T06:37:16Z
• Authors: J Schanz; H Tüchler; F Solé; M Mallo; E Luño; J Cervera; J Grau; B Hildebrandt; M L Slovak; K Ohyashiki; C Steidl; C Fonatsch; M Pfeilstöcker; T Nösslinger; P Valent; A Giagounidis; C Aul; M Lübbert; R Stauder; O Krieger; M M Le Beau; J M Bennett; P Greenberg; U Germing; D Haase
• Keywords: Adult; Male; cytogenetics; Cohort Studies; Cytogenetics; Young Adult; 03 medical and health sciences; Monosomy; 0302 clinical medicine; MDS; Humans; Aged; Aged, 80 and over; Chromosome Aberrations; Monosomal karyotype; Middle Aged; Prognosis; 3. Good health; Survival Rate; Karyotyping; Myelodysplastic Syndromes; Multivariate Analysis; Female; prognosis; monosomal karyotype; Follow-Up Studies

Monosomal karyotype (MK) is associated with an adverse prognosis in patients in acute myeloid leukemia (AML). This study analyzes the prognostic impact of MK in a cohort of primary, untreated patients with myelodysplastic syndromes (MDS). A total of 431 patients were extracted from an international database. To analyze whether MK is an independent prognostic marker in MDS, cytogenetic and clinical data were explored in uni- and multivariate models regarding overall survival (OS) as well as AML-free survival. In all, 204/431 (47.3%) patients with MK were identified. Regarding OS, MK was prognostically significant in patients with ≤ 4 abnormalities only. In highly complex karyotypes (≥ 5 abnormalities), MK did not separate prognostic subgroups (median OS 4.9 months in MK+ vs 5.6 months in patients without MK, P=0.832). Based on the number of abnormalities, MK-positive karyotypes (MK+) split into different prognostic subgroups (MK+ and 2 abnormalities: OS 13.4 months, MK+ and 3 abnormalities: 8.0 months, MK+ and 4 abnormalities: 7.9 months and MK+ and ≥ 5 abnormalities: 4.9 months; P<0.01). In multivariate analyses, MK was not an independent prognostic factor. Our data support the hypothesis that a high number of complex abnormalities, associated with an instable clone, define the subgroup with the worst prognosis in MDS, independent of MK.