Blood Res.  2014 Dec;49(4):234-240. 10.5045/br.2014.49.4.234.

Monosomal and complex karyotypes as prognostic parameters in patients with International Prognostic Scoring System higher risk myelodysplastic syndrome treated with azacitidine

• Hwang KL
• Song MK
• Shin HJ
• Na HJ
• Shin DH
• Kim JK
• Moon JH
• Ahn JS
• Song IC
• Hong J
• Lee GW
• Chung JS

• KMID: 2270680
• DOI: http://doi.org/10.5045/br.2014.49.4.234

Abstract

BACKGROUND
Azacitidine (AZA) is standard care for patients with myelodysplastic syndrome (MDS) who have not had allogeneic stem cell transplantation. Chromosomal abnormalities (CA) including complex karyotype (CK) or monosomal karyotype (MK) are associated with clinical outcome in patients with MDS.
METHODS
We investigated which prognostic factors including CAs would predict clinical outcomes in patients with International Prognostic Scoring System (IPSS) higher risk MDS treated with AZA, retrospectively. CK was defined as the presence of three or more numerical or structural CAs. MK was defined as the presence of two or more distinct autosomal monosomies or single autosomal monosomy with at least one additional structural CA.
RESULTS
A total of 243 patients who treated with AZA, were enrolled. CK was present in 124 patients and MK was present in 90 patients. Bone marrow blasts > or =15% and CK were associated with poorer response (P=0.038, P=0.007) and overall survival (OS) (P<0.001, P<0.001) independently. Although MK in CK group was not associated with prognosis, non-MK status in non-CK group reflected favorable OS (P=0.005). The group including >3 CAs was associated with poorer OS (group including <3 CAs vs. only three CAs, P=0.001; group with >3 CAs vs. only three CAs, P=0.001).
CONCLUSION
CK was an important prognostic parameter associated with worse outcome. MK may predict poor survival in only non-CK status. The higher number of CAs was associated with poorer survival.

Keyword

Myelodysplastic syndrome; Azacitidine; Complex karyotype; Monosomal karyotype; Chromosomal abnormalities

MeSH Terms

Azacitidine*
Bone Marrow
Chromosome Aberrations
Humans
Karyotype*
Monosomy
Myelodysplastic Syndromes*
Prognosis
Retrospective Studies
Stem Cell Transplantation
Azacitidine

Figure

• 

  Fig. 1 Comparisons of overall survival (OS) in patients treated with azacitidine according to the presence of a complex karyotype (CK); chromosomal abnormalities [CA] ≥3 (A) and OS according to the presence of a CK (CA≥3) combined with the monosomal karyotype (MK) (B). OS in the group without CK was significantly lower compared to the group with CK in a median follow-up time of 24.2 months (OS, 21.8% in the group with CK, 37.8% in the group without CK, P <0.001) (A). The MK negative status in the group without CK was higher than the other 3 groups (OS of MK +/- in the group without CK, 18.7% vs. 44.8%; MK +/- in the group with CK, 22.2% vs. 21.4%; P <0.001) (B). However, the differences in OS among the other 3 groups were not significant.

• 

  Fig. 2 Comparisons of overall survival (OS) in patients treated with azacitidine according to the numbers of chromosome abnormalities (CAs); CA <3, CA=3, and CA>3 (A) and OS according to the numbers of CAs combined with the presence or absence of a monosomal karyotype (MK) (B). OS in the group with CA<3 was significantly higher than the other 2 groups (OS, 14.5% in the CA>3 group, 27.9% in the CA=3 group, 37.8% in the CA<3 group; CA<3 vs. CA=3, P=0.001). OS in the CA>3 group was lower than the other 2 groups (CA>3 vs. CA=3, P=0.001) (A). According to the presence or absence of MK combined with the number of CAs, OS was highest in the non-MK group with CA<3 compared to the other 5 groups (OS, 23.3% vs. 50.6% in the CA<3 groups with/without MK, 33.3% vs. 24.4% in the CA=3 groups with/without MK, 11.1% vs. 17.2% in the CA>3 groups with/without MK, P <0.001) (B).

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