Department of Leukemia, the University of Texas, MD Anderson Cancer Center, Houston, Texas.
Am J Hematol. 2013 Oct;88(10):831-7. doi: 10.1002/ajh.23513. Epub 2013 Jul 23.
We hypothesized that the dynamic acquisition of cytogenetic abnormalities (ACA) during the follow up of myelodysplastic syndromes (MDS) could be associated with poor prognosis. We conducted a retrospective analysis of 365 patients with IPSS low or intermediate-1 risk MDS who had at least two consecutive cytogenetic analyses during the follow up. Acquisition of cytogenetic abnormalities was detected in 107 patients (29%). The most frequent alteration involved chromosome 7 in 21% of ACA cases. Median transformation-free and overall survival for patients with and without ACA were 13 vs. 52 months (P = 0.01) and 17 vs. 62 months (P = 0.01), respectively. By fitting ACA as a time-dependent covariate, multivariate Cox regression analysis showed that patients with ACA had increased risk of transformation (HR = 1.40; P = 0.03) or death (HR = 1.45; P = 0.02). Notably, female patients with therapy-related MDS (t-MDS) had an increased risk of developing ACA (OR = 5.26; P < 0.0001), although subgroup analysis showed that prognostic impact of ACA was not evident in t-MDS. In conclusion, ACA occurs in close to one third of patients with IPSS defined lower risk MDS, more common among patients with t-MDS, but has a significant prognostic impact on de novo MDS.
我们假设骨髓增生异常综合征（MDS）患者在随访过程中细胞遗传学异常（ACA）的动态获得可能与预后不良有关。我们对至少有两次连续细胞遗传学分析的 365 例 IPSS 低危或中危-1 风险 MDS 患者进行了回顾性分析。在 107 例患者（29%）中检测到细胞遗传学异常的获得。最常见的改变涉及 ACA 病例中 21%的染色体 7。有和没有 ACA 的患者无转化和总生存的中位数分别为 13 个月与 52 个月（P = 0.01）和 17 个月与 62 个月（P = 0.01）。通过将 ACA 拟合为一个时间依赖性协变量，多变量 Cox 回归分析表明，有 ACA 的患者转化（HR = 1.40；P = 0.03）或死亡（HR = 1.45；P = 0.02）的风险增加。值得注意的是，治疗相关 MDS（t-MDS）的女性患者发生 ACA 的风险增加（OR = 5.26；P < 0.0001），尽管亚组分析显示 ACA 在 t-MDS 中对预后的影响不明显。总之，在 IPSS 定义的低危 MDS 患者中，近三分之一的患者出现 ACA，在 t-MDS 患者中更为常见，但对初发性 MDS 有显著的预后影响。
