A 71-year-old man with a history of cyclophosphamide and radiotherapy for diffuse large B-cell lymphoma five years ago presents with fatigue, recurrent infections, and mucosal bleeding. CBC reveals pancytopenia (Hb 6.8 g/dL, ANC 480/μL, platelets 21,000/μL) with 4% circulating blasts. Bone marrow biopsy shows hypercellular marrow with trilineage dysplasia and 12% myeloblasts consistent with MDS-EB-2. Cytogenetic analysis demonstrates the karyotype marked as **C** in the diagram, showing five independent clonal abnormalities including monosomy 5, monosomy 7, deletion 17p, a marker chromosome, and add(11q). What is the cytogenetic risk category and expected median overall survival for this patient's disease?
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