title: Monosomal and complex karyotypes as prognostic parameters in patients with International Prognostic Scoring System higher risk myelodysplastic syndrome treated with azacitidine.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 (P=0.038, P=0.007) and overall survival (OS) (P<0.001, P<0.001) independently. Although MK in CK group was not associated with prognosis, non-MK status in non-CK group reflected favorable OS (P=0.005). The group including >3 CAs was associated with poorer OS (group including <3 CAs vs. only three CAs, P=0.001; group with >3 CAs vs. only three CAs, P=0.001).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital, Busan, Korea.
authors.forename: Kyung-Lim
authors.initials: KL
authors.lastname: Hwang
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital, Busan, Korea.
authors.forename: Moo-Kon
authors.initials: MK
authors.lastname: Song
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital, Busan, Korea.
authors.forename: Ho-Jin
authors.initials: HJ
authors.lastname: Shin
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital, Busan, Korea.
authors.forename: Hae-Jung
authors.initials: HJ
authors.lastname: Na
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital, Busan, Korea.
authors.forename: Dong-Hun
authors.initials: DH
authors.lastname: Shin
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital, Busan, Korea.
authors.forename: Joong-Keun
authors.initials: JK
authors.lastname: Kim
authors.affiliation: Department of Hematology, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Joon-Ho
authors.initials: JH
authors.lastname: Moon
authors.affiliation: Department of Hematology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
authors.forename: Jae-Sook
authors.initials: JS
authors.lastname: Ahn
authors.affiliation: Department of Hematology, Chungnam Nastional Ujnversity Hospital, Daejeon, Korea.
authors.forename: Ik-Chan
authors.initials: IC
authors.lastname: Song
authors.affiliation: Department of Hematology, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Junshik
authors.initials: J
authors.lastname: Hong
authors.affiliation: Department of Hematology, Gyeong-Sang National University Hospital, School of Medicine, Gyeongsang Natioinal University, Jinju, Korea.
authors.forename: Gyeong-Won
authors.initials: GW
authors.lastname: Lee
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital, Busan, Korea.
authors.forename: Joo-Seop
authors.initials: JS
authors.lastname: Chung
keywords: Azacitidine; Chromosomal abnormalities; Complex karyotype; Monosomal karyotype; Myelodysplastic syndrome