Blood Res 2014; 49(4):
Published online December 31, 2014
https://doi.org/10.5045/br.2014.49.4.234
© The Korean Society of Hematology
1Department of Hematology-Oncology, Pusan National University Hospital, Busan, Korea.
2Department of Hematology, Kyungpook National University Hospital, Daegu, Korea.
3Department of Hematology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
4Department of Hematology, Chungnam Nastional Ujnversity Hospital, Daejeon, Korea.
5Department of Hematology, Gachon University Gil Medical Center, Incheon, Korea.
6Department of Hematology, Gyeong-Sang National University Hospital, School of Medicine, Gyeongsang Natioinal University, Jinju, Korea.
Correspondence to : Correspondence to Joo-Seop Chung, M.D. Department of Hematology-Oncology, School of Medicine, Pusan National University, 179, Gudeok-ro, Seo-gu, Busan 602-739, Korea. Tel: +82-51-240-7225, Fax: +82-51-254-3127, Hemon@pusan.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
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.
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 ≥15% and CK were associated with poorer response (
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.
Keywords Myelodysplastic syndrome, Azacitidine, Complex karyotype, Monosomal karyotype, Chromosomal abnormalities
Blood Res 2014; 49(4): 234-240
Published online December 31, 2014 https://doi.org/10.5045/br.2014.49.4.234
Copyright © The Korean Society of Hematology.
Kyung-Lim Hwang1, Moo-Kon Song1, Ho-Jin Shin1, Hae-Jung Na1, Dong-Hun Shin1, Joong-Keun Kim1, Joon-Ho Moon2, Jae-Sook Ahn3, Ik-Chan Song4, Junshik Hong5, Gyeong-won Lee6, and Joo-Seop Chung1*
1Department of Hematology-Oncology, Pusan National University Hospital, Busan, Korea.
2Department of Hematology, Kyungpook National University Hospital, Daegu, Korea.
3Department of Hematology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
4Department of Hematology, Chungnam Nastional Ujnversity Hospital, Daejeon, Korea.
5Department of Hematology, Gachon University Gil Medical Center, Incheon, Korea.
6Department of Hematology, Gyeong-Sang National University Hospital, School of Medicine, Gyeongsang Natioinal University, Jinju, Korea.
Correspondence to: Correspondence to Joo-Seop Chung, M.D. Department of Hematology-Oncology, School of Medicine, Pusan National University, 179, Gudeok-ro, Seo-gu, Busan 602-739, Korea. Tel: +82-51-240-7225, Fax: +82-51-254-3127, Hemon@pusan.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
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.
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 ≥15% and CK were associated with poorer response (
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.
Keywords: Myelodysplastic syndrome, Azacitidine, Complex karyotype, Monosomal karyotype, Chromosomal abnormalities
Comparisons of overall survival (OS) in patients treated with azacitidine according to the presence of a complex karyotype (CK); chromosomal abnormalities [CA] ≥3 (
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 (
Table 1 . Baseline characteristics of patients..
Abbreviations: RA, refractory anemia; RAEB, refractory anemia with excess blasts; RARS, refractory anemia with ringed sideroblasts; RCMD, refractory cytopenia with multilineage dysplasia; IPSS, International Prognostic Scoring System; ECOG PS, Eastern Cooperative Oncology Group Performance Status; ANC, absolute neutrophil count; PLT, platelet; PB, peripheral blood; BM, bone marrow; M/F, male/female; WHO, World Health Organization..
Table 2 . Overall response in patients treated with azacitidine according to International Working Group 2006 response criteria..
Abbreviations: CR, complete response; IWG, International Working Group..
Table 3 . Prognostic factors for overall response and survival in all patients with myelodysplastic syndrome (N=243)..
Abbreviations: AZA, azacitidin; ANC, absolute neutrophil count; Hb, hemoglobin; PLT, platelet; LDH, lactate dehydrogenase; PB, peripheral blood; BM, bone marrow; RAEB, refractory anemia with excess blasts; IPSS, International Prognostic Scoring System; ECOG PS, Eastern Cooperative Oncology Group Performance Status; CK, complex karyotype; MK, monosomal karyotype; HR, hazard ratio; CI, confidence interval..
Table 4 . Prognostic factors for overall survival in patients with myelodysplastic syndrome with or without complex karyotype..
Abbreviations: AZA, azacitidine; ANC, absolute neutrophil count; Hb, hemoglobin; PLT, platelet; LDH, lactate dehydrogenase; PB, peripheral blood; BM, bone marrow; RAEB, refractory anemia with excess blast; IPSS, International Prognostic Scoring System; ECOG PS, Eastern Cooperative Oncology Group Performance Status; CK, complex karyotype; MK, monosomal karyotype; OS, overall survival; HR, hazard ratio; CI, confidence interval..
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Comparisons of overall survival (OS) in patients treated with azacitidine according to the presence of a complex karyotype (CK); chromosomal abnormalities [CA] ≥3 (
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 (