What is the life expectancy for a 68-year-old male with 52% Monosomy 7, a chromosomal abnormality associated with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML)?

Life Expectancy for 68-Year-Old Male with 52% Monosomy 7

A 68-year-old male with 52% monosomy 7 has a median overall survival of approximately 13-21 months without allogeneic stem cell transplantation, placing him in the high-risk to very high-risk category by IPSS-R criteria. 1

Prognostic Classification and Survival Data

Monosomy 7 is classified as a poor-risk cytogenetic abnormality across all myeloid malignancies. 1 The specific survival depends on whether this represents isolated monosomy 7 or is part of a complex karyotype:

• High-risk category (monosomy 7 as single abnormality or double abnormality including -7/del(7q)): Median overall survival of 21 months 1
• Very high-risk category (complex karyotype with ≥3 abnormalities): Median overall survival of 13 months 1

The 52% monosomy 7 indicates a substantial clonal burden, which typically correlates with more advanced disease. 2

Critical Factors That Modify Prognosis

The actual life expectancy depends on several additional prognostic variables that must be assessed:

• Bone marrow blast percentage: <5% blasts indicates lower-risk MDS with better survival; 5-9% (RAEB-1) or 10-19% (RAEB-2) indicates higher-risk disease with progressively worse outcomes 3
• Number and severity of cytopenias: More cytopenias (hemoglobin <10 g/dL, neutrophils <1800/mcL, platelets <100,000/mcL) worsen prognosis 3
• Presence of additional somatic mutations: Acquisition of SETBP1, ASXL1, RUNX1, or RAS pathway mutations indicates progression toward transformation and worse outcomes 3, 1

Time to AML Transformation

Without treatment, progression to acute myeloid leukemia occurs rapidly:

• High-risk patients: Median time to 25% AML evolution is 1.6 years 1
• Very high-risk patients: Median time to 25% AML evolution is 0.8 years 1

Once transformation to AML occurs, the disease becomes highly resistant to conventional chemotherapy. 2, 4

Impact of Treatment on Survival

Treatment significantly modifies survival outcomes:

Hypomethylating Agents (Azacitidine)

• High-risk patients: Median survival extends to 25 months 1
• Very high-risk patients: Median survival extends to 15 months 1

Allogeneic Hematopoietic Stem Cell Transplantation

This is the only potentially curative therapy and dramatically improves outcomes:

• High-risk patients: Median survival of 40 months 1
• Very high-risk patients: Median survival of 31 months 1

However, at age 68, transplant eligibility depends on performance status, comorbidities, and availability of a suitable donor. 3, 1

Immediate Clinical Actions Required

To refine the prognosis and guide treatment, the following must be performed urgently:

• Complete karyotype analysis of ≥20 metaphases to determine if monosomy 7 is isolated or part of complex abnormalities (≥3 changes) 1
• Bone marrow examination with blast enumeration, multilineage dysplasia assessment, and immunophenotyping 3, 5
• Molecular testing for SETBP1, ASXL1, RUNX1, and RAS pathway mutations, as these indicate imminent transformation 3, 1
• High-resolution HLA typing of patient and first-degree relatives, with simultaneous unrelated donor search if no matched sibling available 1

Common Pitfalls to Avoid

Do not delay transplant evaluation based on age alone. While 68 years is considered older for transplantation, fit patients with good performance status and minimal comorbidities can benefit from reduced-intensity conditioning regimens. 3

Do not assume stable disease will persist. Even if current blood counts are relatively stable, monosomy 7 indicates high risk of rapid progression, particularly if additional mutations are present. 3, 2

Do not rely solely on morphology. The presence of monosomy 7 overrides morphologic classification—even patients with <5% blasts and monosomy 7 have poor prognosis similar to higher-risk disease. 3, 4

Bottom Line for This Patient

Without knowing the complete IPSS-R score (which requires blast percentage, complete cytogenetics, and full cytopenia assessment), the baseline expectation is 13-21 months median survival. 1 This can be extended to 15-25 months with azacitidine or potentially 31-40 months with allogeneic transplantation if the patient is a candidate. 1 The majority of patients will either progress to AML or die from bone marrow failure (infection/hemorrhage) rather than living with stable disease. 3, 4