title: Dismal prognostic value of monosomal karyotype in elderly patients with acute myeloid leukemia: a GOELAMS study of 186 patients with unfavorable cytogenetic abnormalities.
abstract: The prognosis of acute myeloid leukemia (AML) is very poor in elderly patients, especially in those classically defined as having unfavorable cytogenetics. The recent monosomal karyotype (MK) entity, defined as 2 or more autosomal monosomies or combination of 1 monosomy with structural abnormalities, has been reported to be associated with a worse outcome than the traditional complex karyotype (CK). In this retrospective study of 186 AML patients older than 60 years, the prognostic influence of MK was used to further stratify elderly patients with unfavorable cytogenetics. CK was observed in 129 patients (69%), and 110 exhibited abnormalities according to the definition of MK (59%). MK(+) patients had a complete response rate significantly lower than MK(-) patients: 37% vs 64% (P = .0008), and their 2-year overall survival was also decreased at 7% vs 22% (P < .0001). In multivariate analysis, MK appeared as the major independent prognostic factor related to complete remission achievement (odds ratio = 2.3; 95% confidence interval, 1-5.4, P = .05) and survival (hazard ratio = 1.7; 95% confidence interval, 1.1-2.5, P = .008). In the subgroup of 129 CK(+) patients, survival was dramatically decreased for MK(+) patients (8% vs 28% at P = .03). These results demonstrate that MK is a major independent factor of very poor prognosis in elderly AML.
authors.affiliation: Clinical Hematology, University Hospital Nancy Brabois, Vandœuvre-lès-Nancy, France. Aurore.Perrot@medecine.uhp-nancy.fr
authors.forename: Aurore
authors.initials: A
authors.lastname: Perrot
authors.forename: Isabelle
authors.initials: I
authors.lastname: Luquet
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pigneux
authors.forename: Francine
authors.initials: F
authors.lastname: Mugneret
authors.forename: Jacques
authors.initials: J
authors.lastname: Delaunay
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Harousseau
authors.forename: Carole
authors.initials: C
authors.lastname: Barin
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Cahn
authors.forename: Philippe
authors.initials: P
authors.lastname: Guardiola
authors.forename: Chantal
authors.initials: C
authors.lastname: Himberlin
authors.forename: Christian
authors.initials: C
authors.lastname: Recher
authors.forename: Norbert
authors.initials: N
authors.lastname: Vey
authors.forename: Bruno
authors.initials: B
authors.lastname: Lioure
authors.forename: Mario
authors.initials: M
authors.lastname: Ojeda-Uribe
authors.forename: Nathalie
authors.initials: N
authors.lastname: Fegueux
authors.forename: Christian
authors.initials: C
authors.lastname: Berthou
authors.forename: Edouard
authors.initials: E
authors.lastname: Randriamalala
authors.forename: Marie C
authors.initials: MC
authors.lastname: Béné
authors.forename: Norbert
authors.initials: N
authors.lastname: Ifrah
authors.forename: Francis
authors.initials: F
authors.lastname: Witz
mesh_terms: D000368:Aged; D002869:Chromosome Aberrations / Q000706:statistics & numerical data*; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology / Q000235:genetics; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000235:genetics* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009006:Monosomy / Q000235:genetics*; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors