Prognostic value of monosomal karyotype in comparison to complex aberrant karyotype in acute myeloid leukemia: A study on 824 cases with aberrant karyotype

MLL Munich Leukemia Laboratory, Max-Lebsche-Platz 31, Munich, Germany.
Blood (Impact Factor: 10.45). 12/2011; 119(9):2122-5. DOI: 10.1182/blood-2011-10-385781
Source: PubMed


In acute myeloid leukemia (AML) the subset with complex karyotype (CK) is traditionally regarded as the worst prognostic group. However, ≥ 3, ≥ 4, or ≥ 5 abnormalities have been variably used for its definition. Recently, monosomal karyotype (MSK) was suggested to indicate an even inferior outcome. We tested which definition fits best to identify the most unfavorable subgroup. After excluding patients with t(15;17)/PML-RARA, t(8;21)/RUNX1-RUNX1T1, inv (16)/t(16;16)/CBFB-MYH11, and normal karyotype, 824 patients with AML with cytogenetic abnormalities were analyzed. Patients with MSK or CK defined as ≥ 3, ≥ 4, or ≥ 5 abnormalities showed an inferior overall survival compared with the respective remaining patients not fulfilling these criteria (for all, P < .001). Hazard ratios were 1.93, 1.68, 1.94, and 1.92. CK ≥ 4 as a single parameter identified the largest proportion of patients with very poor risk. However, combining CK ≥ 4 and MSK detected an even larger number of patients with very unfavorable outcome (261 of 824; 31.7%).

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Available from: Susanne Schnittger, Nov 10, 2015
    • "Consistent with the well-known association between complex karyotypes and very unfavorable prognoses (median survival 5.7–6.3 months[8]), only two patients in our study are still alive. In a group of patients with three DCs, the median survival was the worst (only 1.8 months) and also the mean age was higher than in other patients with DC (73 years). "
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    • "This observation was confirmed by the Southwest Oncology Group (SWOG), Groupe Ouest Est d'Etude des Leuc emies et Autres Maladies du Sang (GOELAMS), the German-Austrian AML Study Group (Medeiros et al, 2010; Perrot et al, 2011; Kayser et al, 2012) and the Japan Adult Leukaemia Study Group (Yanada et al, 2012) in various age groups and following different protocols. Combination of a monosomal karyotype and multiply complexed karyotype ( ! 4) appears to confer the poorest prognosis (Haferlach et al, 2012a). A commendably exhaustive effort to explore the value of rare cytogenetic aberrations has been conducted by the MRC, with data on 5876 AML patients (Grimwade et al, 2010a) (Fig 2). "
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