@article{3107292,
    title = "The prognostic value of monosomal karyotype (MK) in higher-risk patients with myelodysplastic syndromes treated with 5-Azacitidine: A retrospective analysis of the Hellenic (Greek) Myelodysplastic syndromes Study Group",
    author = "Papageorgiou, S.G. and Vasilatou, D. and Kontos, C.K. and Kotsianidis, I. and Symeonidis, A. and Galanopoulos, A.G. and Hatzimichael, E. and Megalakaki, A. and Poulakidas, E. and Diamantopoulos, P. and Vassilakopoulos, T.P. and Zikos, P. and Papadaki, H. and Mparmparousi, D. and Bouronikou, E. and Panayiotidis, P. and Viniou, N.-A. and Pappa, V.",
    journal = "American Journal of Hematology",
    year = "2018",
    volume = "93",
    number = "7",
    pages = "895-901",
    publisher = "Wiley-Liss, Inc.",
    issn = "0361-8609, 1096-8652",
    doi = "10.1002/ajh.25111",
    keywords = "azacitidine;  hemoglobin;  azacitidine, acute myeloid leukemia;  adult;  aged;  Article;  complex karyotype;  controlled study;  cytogenetics;  disease exacerbation;  drug treatment failure;  female;  follow up;  genetic association;  high risk patient;  human;  human cell;  incidence;  International Prostate Symptom Score;  karyotype;  major clinical study;  male;  monosomal karyotype;  multiple cycle treatment;  myelodysplastic syndrome;  neutrophil count;  oncogenesis and malignant transformation;  overall survival;  platelet count;  predictor variable;  priority journal;  prognosis;  retrospective study;  single drug dose;  cell transformation;  genetics;  Greece;  middle aged;  monosomy;  mortality;  myelodysplastic syndrome;  prognosis;  survival analysis;  treatment outcome;  very elderly, Adult;  Aged;  Aged, 80 and over;  Azacitidine;  Cell Transformation, Neoplastic;  Female;  Greece;  Humans;  Karyotype;  Leukemia, Myeloid, Acute;  Male;  Middle Aged;  Monosomy;  Myelodysplastic Syndromes;  Prognosis;  Retrospective Studies;  Survival Analysis;  Treatment Outcome",
    abstract = "In this study, we investigated the incidence and prognostic impact of monosomal karyotype (MK) in 405 higher-risk Myelodysplastic Syndromes (MDS) patients treated with 5-AZA. The MK was present in 66 out of 405 (16.3%) patients, most of whom had complex karyotype (CK). MK was strongly associated with CK and the cytogenetic risk defined according to IPSS-R, as well as with high-risk disease, according to IPSS (P =.029), IPSS-R (P <.001), and WPSS (P <.001) classification systems. The overall response rate (ORR) was not different between MK+ and MK– patients (46.6% vs. 46.2%). At 28 months median follow-up, the median duration of response was 11 months in the entire cohort, 9.5 months in MK+ patients and 11 months in MK-patients (P =.024). The estimated median time to transformation to acute myeloid leukemia for MK+ patients was 17 months vs. 23 months for MK– patients (P =.025). The estimated median OS for MK+ patients was 12 months vs. 18 months for MK– patients (P <.001). Multivariate Cox regression analysis revealed that performance status (P <.001), IPSS-R (P <.001), and MK (P =.002) were independently associated with overall survival (OS). In a subgroup consisting of high and very-high risk patients according to IPSS-R, MK– patients showed better OS rates compared to MK+ patients (estimated median OS: 17 months vs. 12 months, P =.002). In conclusion, we found that MK is associated with reduced OS in patients with higher-risk MDS treated with 5-AZA. Furthermore, we showed that in MDS with high or very-high IPSS-R risk score, MK can further distinguish patients with worse outcome. © 2018 Wiley Periodicals, Inc."
}