title: Complex, not monosomal, karyotype is the cytogenetic marker of poorest prognosis in patients with primary myelodysplastic syndrome.
abstract: OBJECTIVE
  Complex karyotype (CK) is the poorest risk factor in patients with myelodysplastic syndrome (MDS). It has recently been reported that monosomal karyotype (MK) worsens the prognosis of patients with CK. PATIENTS AND METHODS; We analyzed 1,054 adult patients with MDS with an abnormal karyotype from the Spanish Registry of MDS. The aim of the study was to describe the incidence, characteristics, and prognosis of MK; the main end points were overall survival (OS) and leukemia-free survival.
  
  
  RESULTS
  MK was identified in 172 patients (16%), most of whom (88%) presented with CK. Variables significantly associated with OS were age (hazard ratio [HR], 1.90; P < .001), bone marrow (BM) blast percentage (HR, 1.05; P < .001), hemoglobin level (HR, 1.71; P < .001), platelet count (HR, 1.41; P < .001), karyotype complexity (CK [three abnormalities]: HR, 1.81; P = .003; very CK [> three abnormalities]: HR, 2; P < .001), and abnormalities of chromosome 5 and/or 7 (HR, 1.89; P < .001). Variables significantly related to the risk of transformation to acute myeloid leukemia (AML) were higher BM blast percentage (HR, 1.12; P < .001) and karyotype complexity (CK: HR, 2.53; P = .002; very CK: HR, 2.77; P < .001).
  
  
  CONCLUSIONS
  After accounting for karyotype complexity, MK was not associated with OS or evolution to AML. In conclusion, these results demonstrate that the prognostic value of MK in MDS is not independent and is mainly the result of its strong association with number of chromosomal abnormalities.
authors: Department of Hematology, Vall d'Hebrón University Hospital, Pg. Vall d'Hebrón 119-129, 08035-Barcelona, Spain. dvalcarcel.vhebron@me.com
authors: David
authors: D
authors: Valcárcel
authors: Vera
authors: V
authors: Ademà
authors: Francesc
authors: F
authors: Solé
authors: Margarita
authors: M
authors: Ortega
authors: Benet
authors: B
authors: Nomdedeu
authors: Guillermo
authors: G
authors: Sanz
authors: Elisa
authors: E
authors: Luño
authors: Consuelo
authors: C
authors: Cañizo
authors: Javier
authors: J
authors: de la Serna
authors: Maite
authors: M
authors: Ardanaz
authors: Victor
authors: V
authors: Marco
authors: Rosa
authors: R
authors: Collado
authors: Javier
authors: J
authors: Grau
authors: Julia
authors: J
authors: Montoro
authors: Mar
authors: M
authors: Mallo
authors: Teresa
authors: T
authors: Vallespí
mesh_terms: D059786:Abnormal Karyotype; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007621:Karyotyping; D008297:Male; D008875:Middle Aged; D009006:Monosomy; D009190:Myelodysplastic Syndromes / Q000175:diagnosis* / Q000235:genetics* / Q000401:mortality; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors