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

Abstract

Chromosomal translocations are rare in myelodysplastic syndrome (MDS) and their impact on overall survival (OS) and response to hypomethylating agents (HMA) is unknown. The prognostic impact of the revised International Prognostic Scoring System (IPSS-R) and for chromosomal translocations was assessed in 751 patients from the Korea MDS Registry. IPSS-R effectively discriminated patients according to leukaemia evolution risk and OS. We identified 40 patients (5.3%) carrying translocations, 30 (75%) of whom also fulfilled complex karyotype criteria. Translocation presence was associated with a shorter OS (median, 12.0 versus 79.7 months, P < 0.01). Multivariate analysis demonstrated that translocations (hazard ratio [HR] 1.64 [1.06–2.63]; P = 0.03) as well as age, sex, IPSS-R, and CK were independent predictors of OS. In the IPSS-R high and very high risk subgroup (n = 260), translocations remained independently associated with OS (HR 1.68 [1.06–2.69], P = 0.03) whereas HMA treatment was not associated with improved survival (median OS, 20.9 versus 21.2 months, P = 0.43). However, translocation carriers exhibited enhanced survival following HMA treatment (median 2.1 versus 12.4 months, P = 0.03). Our data suggest that chromosomal translocation is an independent predictor of adverse outcome and has an additional prognostic value in discriminating patients with MDS having higher risk IPSS-R who could benefit from HMA treatment.

Prognostic significance of monosomal karyotype in myelodysplastic syndrome: a meta-analysis

“…After carefully reading the full texts, 13 studies were excluded due to insufficient data. Finally, 17 studies, [8][9][10][11][12][13][14][15][16][17][18][19][20][25][26][27][28] including a letter to the editor [18] were included in this meta-analysis.…”

“…The study conducted by Xing et al [9] included 610 patients, however, followup data were only available in 390 patients who received nonintensive therapies and extracted for this meta-analysis. Of the 17 eligible studies, 5 studies were from North America, [17,[25][26][27][28] 5 from Europe, [13,14,[16][17][18] 6 from Asia, [9,11,12,15,19,20] 1 from Oceania [10]. The median age in 6 studies was over 60 years, [10,[13][14][15]17,19] in 7 studies under 60 years, [11,12,16,20,[25][26][27] and in 4 studies not available [8,9,18,28].…”

“…Of the 17 eligible studies, 5 studies were from North America, [17,[25][26][27][28] 5 from Europe, [13,14,[16][17][18] 6 from Asia, [9,11,12,15,19,20] 1 from Oceania [10]. The median age in 6 studies was over 60 years, [10,[13][14][15]17,19] in 7 studies under 60 years, [11,12,16,20,[25][26][27] and in 4 studies not available [8,9,18,28]. In 10 studies patients were classified by WHO criteria, [9,10,15,17,19,25,27] in 1 study by FAB criteria, [28] in 5 studies by both WHO and FAB criteria, [8,13,16,20,26] but classification criteria were not available in 1 study [18].…”

“…The median age in 6 studies was over 60 years, [10,[13][14][15]17,19] in 7 studies under 60 years, [11,12,16,20,[25][26][27] and in 4 studies not available [8,9,18,28]. In 10 studies patients were classified by WHO criteria, [9,10,15,17,19,25,27] in 1 study by FAB criteria, [28] in 5 studies by both WHO and FAB criteria, [8,13,16,20,26] but classification criteria were not available in 1 study [18]. Patients in 7 studies were treated with allogenetic hematopoietic stem cell transplantation (allo-HSCT), [8,11,12,16,[25][26][27] in 2 studies with hypomethylating agents (HMAs), [15,18] in 1 study were untreated, [13] and in 4 studies were treated with various therapies, from the most conservative best supportive care (BSC) to the most aggressive HSCT, or a blend of several therapies [9,14,19,20].…”

“…MK is considerably overlapped with complex karyotype (CK, defined as at least three cytogenetic abnormalities). Some studies indicated that MK was associated with a significantly inferior OS in MDS with CK, [8,10,17] but others did not yield similar outcomes [14,15,18,19]. Additionally, Monosomies of chromosome 5 and/or 7 were the most frequent monosomies in MK, [20] and several studies reported their controversial impact on OS in MDS with MK [14,[18][19][20].…”