The heterogeneous prognosis of patients with myelodysplastic syndrome and chromosome 5 abnormalities: how does it relate to the original lenalidomide experience in MDS?

Abstract

To define the prognosis in myelodysplastic syndrome (MDS) and deletion 5q with or without other cytogenetic abnormalities. Patients with MDS (<20% blasts) and evaluable cytogenetic studies (1966-present) were reviewed. Outcome of patients with deletion 5q or with loss of chromosome 5 (monosomy 5) was analyzed. Of 2743 patients analyzed, 287 (10%) had deletion 5q and 216 (8%) had monosomy 5 abnormalities. The median survival was 9 months with deletion 5q, 6 months with monosomy 5, and 17 months without a chromosome 5 abnormality. Considering patients with deletion 5q, the median survival was 33 months with deletion 5q alone, 17 months with deletion 5q and 1 additional abnormality, but only 6 months to 12 months with deletion 5q and > or =2 abnormalities or chromosome 7 abnormality. Only 93 patients (3.4% of total) had lower risk MDS (international prognostic scoring system low or intermediate 1) and deletion 5q; their median survival was 29 months (2-year survival 60%), and ranged from 13-41 months depending on the presence or absence of additional chromosomal abnormalities. Among 198 patients with MDS with deletion 5q and <10% blasts (a subset now often offered lenalidomide), the median survival was 12 months. Monosomy 5 was significantly more frequently associated with advanced MDS and with other chromosomal abnormalities. This study provided baseline expectations of outcome in different MDS subsets and deletion 5q.