title: Monosomal karyotype improves IPSS-R stratification in MDS and AML patients treated with Azacitidine.
abstract: IPSS-R classifies cytogenetic abnormalities into five prognostic groups for survival. Monosomal karyotype (MK) is not a subgroup of IPSS-R. Additional prognostic information from MK in poor and very poor karyotype has been recently shown. The aim of our study was to determine the prognostic value of IPSS-R and MK for response and survival in AZA-treated high-risk MDS and AML with 20-30% of blasts patients. The study population included 154 patients who were classified according to IPSS-R. IPSS-R was not predictive of response (intermediate, 64%; poor, 44%; very poor, 56%; P = 0.28) or survival (intermediate, 25 months; poor, 12 months; very poor, 11 months; P = 0.14). Twenty-one patients (15%) presented with MK and had a median OS of 9 months. Patients with a very high IPSS-R score without MK had a median OS of 15 months, while patients with a high IPSS-R score without MK had a median OS of 13 months (P = 0.18). We reclassified patients into the following three groups to include MK status: very high (MK only; OS median: 9 months), high (very high IPSS-R without MK and high IPSS-R without MK; OS median: 14 months) and intermediate (OS median: 25 months). As in recent publication including MK prognostic, we confirmed that this classification was predictive for survival in AZA treated patients (P = 0.008). IPSS-R failed to discriminate between the prognostic subgroups. Stratification with MK has value in the prognosis of our cohort of AZA-treated patients.
authors.affiliation: Centre Méditerranéen de médecine moléculaire, INSERM U1065, CHU Nice, Hôpital Archet 1, Service Hématologie Clinique, 151 Route Saint Antoine de Ginestière, Nice, France. cluzeau.thomas@gmail.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Cluzeau
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mounier
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Karsenti
authors.forename: Valentine
authors.initials: V
authors.lastname: Richez
authors.forename: Laurence
authors.initials: L
authors.lastname: Legros
authors.forename: Lauris
authors.initials: L
authors.lastname: Gastaud
authors.forename: Georges
authors.initials: G
authors.lastname: Garnier
authors.forename: Daniel
authors.initials: D
authors.lastname: Re
authors.forename: Nathalie
authors.initials: N
authors.lastname: Montagne
authors.forename: Jean
authors.initials: J
authors.lastname: Gutnecht
authors.forename: Jean
authors.initials: J
authors.lastname: Gabriel Fuzibet
authors.forename: Patrick
authors.initials: P
authors.lastname: Auberger
authors.forename: Sophie
authors.initials: S
authors.lastname: Raynaud
authors.forename: Jill-Patrice
authors.initials: JP
authors.lastname: Cassuto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001374:Azacitidine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D059785:Karyotype; D007621:Karyotyping / Q000145:classification*; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009006:Monosomy; D009190:Myelodysplastic Syndromes / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D001374:Azacitidine