title: Monosomal karyotype predicts inferior survival independently of a complex karyotype in patients with myelodysplastic syndromes.
abstract: BACKGROUND
  Conflicting data exist about the impact of a monosomal karyotype (MK) on overall survival (OS) for patients with myelodysplastic syndromes (MDSs) and particularly for those with a complex karyotype (CK). This study was aimed at determining whether an MK is associated with OS independently of the number of cytogenetic abnormalities (CAs) in a population-based MDS cohort.
  
  
  METHODS
  Cancer registry data on incident MDS cases were linked with cytogenetic data and hospital administrative data from 2000 to 2010 for the Australian state of Victoria.
  
  
  RESULTS
  Between 2000 and 2010, 1404 incident MDS cases with cytogenetic results were identified. A CK, defined as 3 or more abnormalities, was present in 126 (9%). A very complex karyotype (vCK), defined as 5 or more abnormalities, was present in 95 (7%). An MK was associated with worse OS in the whole cohort (median 6 vs 39 months, P < 0.001) including those with a coexisting CK (6 vs 17 months, P < 0.001) or vCK (6 vs 9 months, P = 0.02). After adjustments for the number of CAs, an MK remained independently associated with OS, although its effect size decreased with increasing cytogenetic complexity (hazard ratio for an MK, 4.81; 95% confidence interval, 3.08-7.52; hazard ratio for the number of CAs, 1.22; 95% confidence interval, 1.15-1.30; and hazard ratio for the interaction between an MK and CAs, 0.83; 95% confidence interval, 0.77-0.89).
  
  
  CONCLUSIONS
  These results support the clinical utility of an MK as an independent predictor of adverse outcomes for MDS patients, even among CK and vCK groups, although its prognostic effect decreases with increasing cytogenetic complexity.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Zoe K
authors.initials: ZK
authors.lastname: McQuilten
authors.affiliation: Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia.
authors.forename: Vijaya
authors.initials: V
authors.lastname: Sundararajan
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Nick
authors.initials: N
authors.lastname: Andrianopoulos
authors.affiliation: Australian Centre for Blood Diseases, Monash University, Melbourne, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Curtis
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.|Australian Centre for Blood Diseases, Monash University, Melbourne, Australia.
authors.forename: Erica M
authors.initials: EM
authors.lastname: Wood
authors.affiliation: Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia.|Victorian Cancer Cytogenetics Service, St Vincent's Hospital, Melbourne, Australia.
authors.forename: Lynda J
authors.initials: LJ
authors.lastname: Campbell
authors.affiliation: Victorian Cancer Cytogenetics Service, St Vincent's Hospital, Melbourne, Australia.
authors.forename: Meaghan
authors.initials: M
authors.lastname: Wall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D059785:Karyotype; D008297:Male; D009006:Monosomy; D009190:Myelodysplastic Syndromes / Q000235:genetics* / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies
keywords: cytogenetics; monosomal karyotype; myelodysplastic syndromes; survival