Prognostic significance of monosomal karyotype in myelodysplastic syndrome: a meta-analysis

ABSTRACT Objectives: In myelodysplastic syndrome (MDS), the prognostic role of monosomal karyotype (MK), defined as at least two autosomal monosomies or a single monosomy associated with at least one additional structural abnormality, remained controversial. Therefore, we conducted a meta-analysis to address this issue. Methods: PubMed, Embase, Web of Science, Medline, and the Cochrane Library were retrieved. We extracted hazard ratios (HRs) and the corresponding 95% confidential intervals (CIs) for overall survival (OS) on patients with MK versus those without, as well as on MK patients with monosomies of chromosome 7 and/or 5 versus those without from the available studies. Results: Seventeen studies covering 7500 patients were included this meta-analysis. The pooled HRs indicated MK had a negative impact on OS in MDS (pooled HR: 2.484, 95%CI: 2.033–3.036, P？<？.001), in MDS patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) (pooled HR: 2.150, 95%CI: 1.861–2.48, P？<？.001), and in MDS with complex karyotype (CK) (pooled HR: 2.56, 95%CI: 2.032–3.036, P？=？.01). However, monosomies of chromosome 5 and/or 7 had no impact on OS in MDS with MK (pooled HR: 1.330, 95%CI: 0.827–2.139, P？=？.240). Meta-regression indicated that therapy was the origin of the heterogeneity (P？=？.012). Discussion: Our meta-analysis indicated that MK has a negative impact on OS in MDS, in MDS patients undergoing allo-HSCT, and MDS with CK, but monosomies of chromosome 5 and/or 7 have no impact on OS in MDS with MK. The heterogeneity reflected the biologic and therapeutic heterogeneity of MDS. Conclusion: MK is associated with poor prognosis in MDS, the underlying mechanism needs further exploring