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Leuk Res. 2018 Apr;67:21-26. doi: 10.1016/j.leukres.2018.01.022. Epub 2018 Jan 31.

Prognostic impact of a suboptimal number of analyzed metaphases in normal karyotype lower-risk MDS.

Author information

1
Dep. of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.
2
Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom.
3
Dep. of Haematology and Oncology, Georg August University of Göttingen, Göttingen, Germany.
4
Service d'Hématologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris (AP-HP) and Université Paris 7, Paris, France.
5
Dep. of Medicine, Div. Hematology, University of Patras Medical School, Patras, Greece.
6
Dep. of Clinical Hematology, Inst. of Hematology & Blood Transfusion, Praha, Czech Republic.
7
Dep. of Haematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
8
Dep. of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria.
9
Dep. of Medicine A, Tel Aviv Sourasky (Ichilov) Medical Center and Sackler Medical Faculty, Tel Aviv University, Tel Aviv, Israel.
10
Dep. of Medicine, Div. Hematology, Karolinska Institutet, Stockholm, Sweden.
11
Dep. of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
12
Dep. of Haematology, Aarhus University Hospital, Aarhus, Denmark.
13
Dep. of Haematology, Oncology and Internal Medicine, Warszawa Medical University, Warszawa, Poland.
14
Dep. of Haematology, Oncology and Clinical Immunology, Universitätsklinik Düsseldorf, Düsseldorf, Germany.
15
Serviço de Hematologia - Instituto Português de Oncologia de Lisboa, Francisco Gentil, Lisbon, Portugal.
16
Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
17
Clinic of Hematology - Clinical Center of Vojvodina, University of Novi Sad, Novi Sad, Serbia.
18
Dep. of Internal Medicine, Division of Hematology, Merkur University Hospital, Zagreb, Croatia.
19
Service d'Hématologie, Centre Hospitalier Universtaire Brabois Vandoeuvre, Nancy, France.
20
Service d'Hématologie, Centre Hospitalier de Perpignan, Perpignan, France.
21
Servicio d'Hematología, Servicio de Salud del Principado de Asturias, Oviedo, Spain.
22
Dep. of Haematology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom.
23
Service d'Hématologie, Centre Hospitalier Universitaire de Purpan, Toulouse, France.
24
Dep. of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria.
25
St. James's Institute of Oncology, Leeds Teaching Hospitals, Leeds, United Kingdom.
26
Dep. of Tumor Immunology - Nijmegen Center for Molecular Life Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Electronic address: Theo.dewitte@radboudumc.nl.

Abstract

Conventional karyotype is one of the most relevant prognostic factors in MDS. However, about 50% of patients with MDS have a normal karyotype. Usually, 20-25 normal metaphases (nMP) are considered to be optimal to exclude small abnormal clones which might be associated with poor prognosis. This study evaluated the impact of examining a suboptimal number of metaphases in patients recruited to the EUMDS Registry with low and intermediate-1 risk according to IPSS. Only 179/1049 (17%) of patients with a normal karyotype had a suboptimal number of nMP, defined as less than 20 metaphases analyzed. The outcome (overall survival and progression-free survival) of patients with suboptimal nMP was not inferior to those with higher numbers of analyzed MP both in univariate and multivariate analyses. For patients with an abnormal karyotype, 224/649 (35%) had a suboptimal number of MP assessed, but this did not impact on outcome. For patients with a normal karyotype and suboptimal numbers of analyzable metaphases standard evaluation might be acceptable for general practice, but we recommend additional FISH-analyses or molecular techniques, especially in candidates for intensive interventions.

KEYWORDS:

Cytogenetics; Karyotype; Lower-risk; Metaphases; Myelodysplastic syndromes; Overall survival; Progression-free survival

PMID:
29407183
DOI:
10.1016/j.leukres.2018.01.022
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