Impact of TP53 Allelic State on Outcomes of Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation for Myelodysplastic Neoplasm

Background : Tumor protein p53 ( TP53) mutations are associated with dismal outcomes in myelodysplastic neoplasms (MDS). However, the impact of TP53 allelic state in the context of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for MDS has not been fully explored. Method: We conducted a multi-center study in 347 MDS patients undergoing allo-HSCT between January 2017 and October 2022, with the median follow-up time among survivors of 28.6 (range, 4.7 - 76.6) months, and 45 had TP53 mutations among them. Results: Twenty-one patients were detected with TP53 monoallelic mutations ( TP531mut), while 24 had multiple hits ( TP53multi). Complex karyotype was more common in patients with mutated TP53 (52.4% of patients with TP531mutand 75.0% of patients with TP53multi), whereas this proportion was only 10.6% in patients with wild-type TP53 ( TP53wt). The prognosis varied according to different TP53 state, showing the 2-year overall survival (OS) rates of 51.4% (95% confidence interval [CI]: 33.7% - 78.6%) for TP531mut group versus 15.8% (95% CI: 3.3% - 76.4%) for TP53multi group versus 73.5% (95% CI: 68.5% - 78.9%) for TP53wt group ( P