***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND A complete remission is essential for prolonging survival in patients with acute myeloid leukemia ( AML ) .  Daunorubicin is a cornerstone of the induction regimen , but the optimal dose is unknown . In older patients , it is usual to give daunorubicin at a dose of 45 to 50 mg per square meter of body-surface area . METHODS Patients in whom AML or high-risk refractory anemia had been newly diagnosed and who were 60 to 83 years of age ( median , 67 ) were r and omly assigned to receive cytarabine , at a dose of 200 mg per square meter by continuous infusion for 7 days , plus daunorubicin for 3 days , either at the conventional dose of 45 mg per square meter ( 411 patients ) or at an escalated dose of 90 mg per square meter ( 402 patients ) ; this treatment was followed by a second cycle of cytarabine at a dose of 1000 mg per square meter every 12 hours [ DOSAGE ERROR CORRECTED ] for 6 days . The primary end point was event-free survival . RESULTS The complete remission rates were 64 % in the group that received the escalated dose of daunorubicin and 54 % in the group that received the conventional dose ( P=0.002 ) ; the rates of remission after the first cycle of induction treatment were 52 % and 35 % , respectively ( P<0.001 ) . There was no significant difference between the two groups in the incidence of hematologic toxic effects , 30-day mortality ( 11 % and 12 % in the two groups , respectively ) , or the incidence of moderate , severe , or life-threatening adverse events ( P=0.08 ) . Survival end points in the two groups did not differ significantly overall , but patients in the escalated-treatment group who were 60 to 65 years of age , as compared with the patients in the same age group who received the conventional dose , had higher rates of complete remission ( 73 % vs. 51 % ) , event-free survival ( 29 % vs. 14 % ) , and overall survival ( 38 % vs. 23 % ) . CONCLUSIONS In patients with AML who are older than 60 years of age , escalation of the dose of daunorubicin to twice the conventional dose , with the entire dose administered in the first induction cycle , effects a more rapid response and a higher response rate than does the conventional dose , without additional toxic effects . ( Current Controlled Trials number , IS RCT N77039377 ; and Netherl and s National Trial Register number , NTR212 . Cytogenetics is considered one of the most valuable prognostic determinants in acute myeloid leukemia ( AML ) . However , many studies on which this assertion is based were limited by relatively small sample sizes or varying treatment approach , leading to conflicting data regarding the prognostic implication s of specific cytogenetic abnormalities . The Medical Research Council ( MRC ) AML 10 trial , which included children and adults up to 55 years of age , not only affords the opportunity to determine the independent prognostic significance of pretreatment cytogenetics in the context of large patient groups receiving comparable therapy , but also to address their impact on the outcome of subsequent transplantation procedures performed in first complete remission ( CR ) . On the basis of response to induction treatment , relapse risk , and overall survival , three prognostic groups could be defined by cytogenetic abnormalities detected at presentation in comparison with the outcome of patients with normal karyotype . AML associated with t(8;21 ) , t(15;17 ) or inv(16 ) predicted a relatively favorable outcome . Whereas in patients lacking these favorable changes , the presence of a complex karyotype , -5 , del(5q ) , -7 , or abnormalities of 3q defined a group with relatively poor prognosis . The remaining group of patients including those with 11q23 abnormalities , + 8 , + 21 , + 22 , del(9q ) , del(7q ) or other miscellaneous structural or numerical defects not encompassed by the favorable or adverse risk groups were found to have an intermediate prognosis . The presence of additional cytogenetic abnormalities did not modify the outcome of patients with favorable cytogenetics . Subgroup analysis demonstrated that the three cytogenetically defined prognostic groups retained their predictive value in the context of secondary as well as de novo AML , within the pediatric age group and furthermore were found to be a key determinant of outcome from autologous or allogeneic bone marrow transplantation ( BMT ) in first CR . This study highlights the importance of diagnostic cytogenetics as an independent prognostic factor in AML , providing the framework for a stratified treatment approach of this disease , which has been adopted in the current MRC AML 12 trial Cytogenetic classification by the revised international prognostic scoring system ( IPSS‐R ) and the prognostic value of monosomal karyotype ( MK ) were assessed in 783 patients with primary myelodysplastic syndromes ( MDS ) . At 22 months median follow‐up , 562 ( 72 % ) deaths were recorded . Percentages of patients with IPSS‐R “ very good , ” “ good , ” “ intermediate , ” “ poor , ” and “ very poor ” cytogenetic categories was 5 , 63 , 18 , 4 , and 10 % , respectively . The corresponding median survivals were 21 , 40 , 24 , 18 , and 6.5 months and the inter‐group differences ( good vs. very good/intermediate/poor vs. very poor ; P < 0.01 ) or similarities ( very good vs. intermediate vs. poor ; P = 0.79 ) were not significantly modified in multivariable analysis . Results were similar when analysis was restricted to 602 patients managed by supportive care .  MK adversely affected survival in both poor and very poor karyotype groups ( P < 0.01 ) . In conclusion , we were unable to confirm the prognostic superiority of IPSS‐R‐very good karyotype or prognostically distinguish between very good , intermediate and poor karyotypes . Furthermore , we show additional prognostic information from MK in poor/very poor karyotype . Am . J. Hematol . 88:690–693 , 2013 . © 2013 Wiley Periodicals , BACKGROUND Drug treatments for patients with high-risk myelodysplastic syndromes provide no survival advantage . In this trial , we aim ed to assess the effect of azacitidine on overall survival compared with the three commonest conventional care regimens . METHODS In a phase III , international , multicentre , controlled , parallel-group , open-label trial , patients with higher-risk myelodysplastic syndromes were r and omly assigned one-to-one to receive azacitidine ( 75 mg/m(2 ) per day for 7 days every 28 days ) or conventional care ( best supportive care , low-dose cytarabine , or intensive chemotherapy as selected by investigators before r and omisation ) . Patients were stratified by French-American-British and international prognostic scoring system classifications ; r and omisation was done with a block size of four . The primary endpoint was overall survival . Efficacy analyses were by intention to treat for all patients assigned to receive treatment . This study is registered with Clinical Trials.gov , number NCT00071799 . FINDINGS Between Feb 13 , 2004 , and Aug 7 , 2006 , 358 patients were r and omly assigned to receive  azacitidine ( n=179 ) or conventional care regimens ( n=179 ) . Four patients in the azacitidine and 14 in the conventional care groups received no study drugs but were included in the intention-to-treat efficacy analysis . After a median follow-up of 21.1 months ( IQR 15.1 - 26.9 ) , median overall survival was 24.5 months ( 9.9-not reached ) for the azacitidine group versus 15.0 months ( 5.6 - 24.1 ) for the conventional care group ( hazard ratio 0.58 ; 95 % CI 0.43 - 0.77 ; stratified log-rank p=0.0001 ) . At last follow-up , 82 patients in the azacitidine group had died compared with 113 in the conventional care group . At 2 years , on the basis of Kaplan-Meier estimates , 50.8 % ( 95 % CI 42.1 - 58.8 ) of patients in the azacitidine group were alive compared with 26.2 % ( 18.7 - 34.3 ) in the conventional care group ( p<0.0001 ) . Peripheral cytopenias were the most common grade 3 - 4 adverse events for all treatments . INTERPRETATION Treatment with azacitidine increases overall survival in patients with higher-risk myelodysplastic syndromes relative to conventional care A monosomal karyotype ( MK ) , defined as ≥2 autosomal monosomies or a single monosomy in the presence of additional structural abnormalities , was recently identified as an independent prognostic factor conveying an extremely poor prognosis in patients with acute myeloid leukemia ( AML ) . In the present study , after excluding patients with t(15;17 ) , t(8;21 ) , inv(16 ) and normal karyotypes , 324 AML patients with cytogenetic abnormalities were the main subject of analysis . The incidences of MK were 13 % in patients aged 15 to 60 years and 18 % in those between 15 and 88 years old .  MK was much more prevalent among elderly patients ( p<0.001 ) and was significantly associated with the presence of -7 , -5 , del(5q ) , abn12p , abn17p , -18 or 18q- , -20 or 20q- and CK ( for all p<0.001 except for abn12p p=0.009 ) , and + 8 or + 8q was less frequent in MK+ AML(p=0.007 ) . No correlation was noted between monosomal karyotype and FAB subtype ( p>0.05 ) ; MK remained significantly associated with worse overall survival among patients with complex karyotype ( p=0.032 ) ; A single autosomal monosomy contributed an additional negative effect in OS of patients with structural cytogenetic abnormalities ( P=0.008 ) . This report presents the prevalence , feature and prognostic impact of MK among a large series of Chinese AML patients from a single center for the first time Diagnostic karyotype provides the framework for risk-stratification schemes in acute myeloid leukemia ( AML ) ; however , the prognostic significance of many rare recurring cytogenetic abnormalities remains uncertain . We studied the outcomes of 5876 patients ( 16 - 59 years of age ) who were classified into 54 cytogenetic subgroups and treated in the Medical Research Council trials . In multivariable analysis , t(15;17)(q22;q21 ) , t(8;21)(q22;q22 ) , and inv(16)(p13q22)/t(16;16)(p13;q22 ) were the only abnormalities found to predict a relatively favorable prognosis ( P < .001 ) . In patients with t(15;17 ) treated with extended all-trans retinoic acid and anthracycline-based chemotherapy , additional cytogenetic changes did not have an impact on prognosis . Similarly , additional abnormalities did not have a significant adverse effect in t(8;21 ) AML ; whereas in patients with inv(16 ) , the presence of additional changes , particularly + 22 , predicted a better outcome ( P = .004 ) . In multivariable analyses , various abnormalities predicted a significantly poorer outcome , namely abn(3q ) ( excluding t(3;5)(q25;q34 ) ) , inv(3)(q21q26)/t(3;3)(q21;q26 ) , add(5q)/del(5q ) , -5 , -7 , add(7q)/del(7q ) , t(6;11)(q27;q23 ) , t(10;11)(p11 approximately 13;q23 ) , other t(11q23 ) ( excluding t(9;11)(p21 approximately 22;q23 ) and t(11;19)(q23;p13 ) ) , t(9;22)(q34;q11 ) , -17 , and abn(17p ) . Patients lacking the aforementioned favorable or adverse aberrations but with 4 or more unrelated abnormalities also exhibited a significantly poorer prognosis ( design ated " complex " karyotype group ) . These data allow more reliable prediction of outcome for patients with rarer abnormalities and may facilitate the development of consensus in reporting of karyotypic information in clinical trials involving younger adults with AML . This study is registered at http://www.is rct n.org as IS RCT N55678797 and IS RCT N17161961 Metaphase karyotyping is an established diagnostic st and ard in acute myeloid leukemia ( AML ) for risk stratification . One of the cytogenetic findings in AML is structurally highly abnormal marker chromosomes . In this study , we have assessed frequency , cytogenetic characteristics , prognostic 
    Output:
    
This analysis of the literature confirms the negative prognostic impact on survival of the MK in myeloid neoplasias .