Monosomal karyotype improves IPSS‐R stratification in MDS and AML patients treated with Azacitidine

Abstract

IPSS-R classifies cytogenetic abnormalities into five prognostic groups for survival. Monosomal karyotype (MK) is not a subgroup of IPSS-R. Additional prognostic information from MK in poor and very poor karyotype has been recently shown. The aim of our study was to determine the prognostic value of IPSS-R and MK for response and survival in AZA-treated high-risk MDS and AML with 20-30% of blasts patients. The study population included 154 patients who were classified according to IPSS-R. IPSS-R was not predictive of response (intermediate, 64%; poor, 44%; very poor, 56%; P 5 0.28) or survival (intermediate, 25 months; poor, 12 months; very poor, 11 months; P 5 0.14). Twenty-one patients (15%) presented with MK and had a median OS of 9 months. Patients with a very high IPSS-R score without MK had a median OS of 15 months, while patients with a high IPSS-R score without MK had a median OS of 13 months (P 5 0.18). We reclassified patients into the following three groups to include MK status: very high (MK only; OS median: 9 months), high (very high IPSS-R without MK and high IPSS-R without MK; OS median: 14 months) and intermediate (OS median: 25 months). As in recent publication including MK prognostic, we confirmed that this classification was predictive for survival in AZA treated patients (P 5 0.008). IPSS-R failed to discriminate between the prognostic subgroups. Stratification with MK has value in the prognosis of our cohort of AZA-treated patients. Am. J.

Prognostic Impact of IPSS-R and Chromosomal Translocations in 751 Korean Patients with Primary Myelodysplastic Syndrome

“…The question of whether MK represents an independent prognostic factor of survival has been a focus of attention with many studies devoted to the subject. MK has been reported as a poor prognostic indicator in the whole patient population [17–20], as well as in patients treated with HMAs [21,22]. However, Valcárcel et al reported that the prognostic value of MK is the result of its strong association with a number of chromosomal abnormalities [23]; our study supports this finding by showing that in the context of CK, MK loses its prognostic significance.…”

Monosomal karyotype is an independent predictor of survival in patients with higher‐risk myelodysplastic syndrome

“…The prognostic importance of a MK in estimating the survival of patients with MDS is controversial . Our data demonstrated a significant impact of a MK on patient survival independent of age and IPSS‐R and WPSS risk scores.…”

Monosomal karyotype in myeloid neoplasias: a literature review

“…Several conflicting reports (summarized in Table 2) on the impact of the MK as an independent predictor of survival in MDS have drawn attention to the importance of considering the prognostic weight of complex aberrations in association with autosomal monosomies 38–43. In a recent study including only CK MDS patients from the Mayo Clinic database, the authors suggested that MK+ is associated with a lower OS:38 the OS was significantly inferior in patients with MK+ compared with those with a CK without monosomies, and the median survival of patients with a CK without monosomies was 13 months vs 7 months in patients with MK+.…”