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Prognostic significance of monosomal karyotype in higher risk myelodysplastic syndrome treated with azacitidine

Leukemia volume 25, pages 1207–1209 (2011)Cite this article

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We read with great interest the report by Patnaik et al.1 stating that the monosomal karyotype in myelodysplastic syndromes (MDS), with or without monosomy 7 or 5, is prognostically worse than other complex karyotypes. Monosomal karyotype (MK) has been defined by Breems et al.2 in acute myeloid leukemia (AML) as the presence of at least two autosomal monosomies or of a single monosomy associated to at least one structural abnormality.3 In the report by Patnaik et al. in MDS, 83% of complex karyotypes (defined according to the international prognostic scoring system (IPSS) criteria as the presence of three or more independent chromosomal aberrations) were monosomal, and those patients had indeed poorer prognosis, in terms of overall (OS) and progression-free survival, than other MDS with complex karyotype. Presence of monosomy 5 (−5) or 7 (−7) did not add further prognostic value to MK; del 5q and del 7q were not considered in that analysis.

In this IPSS classification, complex karyotypes are grouped with non-complex chromosome 7 aberrations in the ‘poor-risk’ cytogenetic category. Most patients with poor-risk cytogenetics are classified as higher risk (IPSS intermediate-2 or high) patients. Hypomethylating agents are active in those patients.4, 5 In particular, azacitidine (AZA) has demonstrated a survival benefit over conventional care regimens in higher risk MDS (including AML with 20–30% blasts)6 and has become the standard of care in those patients (at least for those not eligible for allogeneic stem cell transplantation). Studies of MK in AML have been conducted in patients receiving intensive chemotherapy.2, 3 The MDS study of Patnaik et al.1 included patients analyzed between 1990 and 2010, and thus probably only a fraction of those patients had received hypomethylating agents. We thought useful to review the prognostic value of MK in higher risk MDS treated with AZA.

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References

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Authors and Affiliations

  1. Clinical Hematology Department, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris and Paris 13 University, Bobigny, France

    R Itzykson, S Thépot, S Boehrer, C Gardin, L Adès & P Fenaux

  2. Hematology Laboratory Department, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris and Paris 13 University, Bobigny, France

    V Eclache

  3. Clinical Hematology Department, Centre Hospitalier Universitaire Lille, Lille, France

    B Quesnel

  4. Clinical Hematology Department, Hôpital Cochin, AP-HP and Paris 5 University, Paris, France

    F Dreyfus

  5. Internal Medecine Department, Centre Hospitalier Universitaire Toulouse, Toulouse, France

    O Beyne-Rauzy

  6. Clinical Hematology Department, Centre Hospitalier Universitaire Limoges, Limoges, France

    P Turlure

  7. Clinical Hematology Department, Institut Paoli Calmettes, Marseille, France

    N Vey

  8. Clinical Hematology Department, Centre Hospitalier Universitaire Toulouse, Toulouse, France

    C Recher

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  1. R Itzykson
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on behalf of the Groupe Francophone des Myelodysplasies (GFM)

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Correspondence to P Fenaux.

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PF has received the Honoraria and Research Funding from Celgene. The remaining authors declare no conflict of interests.

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Itzykson, R., Thépot, S., Eclache, V. et al. Prognostic significance of monosomal karyotype in higher risk myelodysplastic syndrome treated with azacitidine. Leukemia 25, 1207–1209 (2011). https://doi.org/10.1038/leu.2011.63

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