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ACUTE MYELOID LEUKEMIA

Survival of TP53-mutated acute myeloid leukemia patients receiving allogeneic stem cell transplantation after first induction or salvage therapy: results from the Consortium on Myeloid Malignancies and Neoplastic Diseases (COMMAND)

Leukemia volume 37, pages 799–806 (2023)Cite this article

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Abstract

We conducted a multi-center study to analyze factors predicting survival among patients with TP53-mutated (m) AML receiving allogeneic hematopoietic stem cell transplant (allo-HSCT) in the recent era. Out of 370 TP53m AML patients, 68 (18%) patients were bridged to allo-HSCT. The median age of the patients was 63 years (range, 33–75), 82% of patients had complex cytogenetics and 66% of patients had multi-hit TP53m. Forty three percent received myeloablative conditioning and 57% received reduced intensity conditioning. The incidence of acute graft versus host disease (GVHD) was 37% and chronic GVHD was 44%. The median event-free survival (EFS) from the time of allo-HSCT was 12.4 months (95% CI: 6.24–18.55) and median overall survival (OS) was 24.5 months (95% CI: 21.80–27.25). In multivariate analysis utilizing variables that showed significance in univariate analysis, complete remission at day 100 post allo-HSCT retained significance for EFS (HR: 0.24, 95% CI: 0.10–0.57, p = 0.001) and OS (HR: 0.22, 95% CI: 0.10–0.50, p ≤ 0.001). Similarly, occurrence of chronic GVHD retained significance for EFS (HR: 0.21, 95% CI: 0.09–0.46, p ≤ 0.001) and OS (HR: 0.34, 95% CI: 0.15–0.75, p = 0.007). Our report suggests that allo-HSCT offers the best opportunity to improve long-term outcome among patients with TP53m AML.

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Fig. 1: Flow chart of patients enrolled in the study.
Fig. 2: Event-free and Overall Survival.
Fig. 3: Univariate analysis for EFS.
Fig. 4: Univariate analysis for OS.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Division of Hematology and Oncology, Mayo Clinic Florida, Jacksonville, FL, USA

    Talha Badar

  2. Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI, USA

    Ehab Atallah & Guru Subramanian Guru Murthy

  3. Yale University School of Medicine, New Haven, CT, USA

    Rory Shallis, Jan P. Bewersdorf & Mark R. Litzow

  4. Division of Hematology, Mayo Clinic, Rochester, MN, USA

    Antoine N. Saliba

  5. Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA

    Anand Patel & Adam Duvall

  6. New York Presbyterian/Weill-Cornell Medical Center, New York, NY, USA

    Justin Grenet

  7. Department of Medical Oncology, Dana-Farber Institute, Boston, MA, USA

    Maximilian Stahl

  8. Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA

    Madelyn Burkart, Shira Dinner & Yasmin Abaza

  9. Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Neil Palmisiano

  10. Division of Hematology/Oncology, Georgia Cancer Center at Augusta University, Augusta, GA, USA

    Danielle Bradshaw, Michal Kubiak & Vamsi Kota

  11. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Aaron D. Goldberg

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Contributions

TB: Conceptualization, data curation, writing original draft, and submission. EA, RMS, AP, ANS: contributed patients, review and edit manuscript. MB, JPB, MS, GCC, GM, YA, AD, DB, VK, SD, ADG, NP, AAK: contributed patients and review manuscript. MRL: contributed patients, supervise, review, and edit the manuscript.

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Correspondence to Talha Badar.

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Competing interests

TB: Received Mayo Clinic Cancer Center Support Grant (P30 CA015083), serve in advisory board for Pfizer and Takeda AP: Consulting for Abbvie, research funding from Kronos Bio, Pfizer, Celgene/BMS, Servier, VK: Advisory board for Novartis and Pfizer, MS: Consulting for Curis Oncology, advisory board for Novartis, Kymera, Sierra Oncology, participated in GME activities for Novartis, Curis Oncology, Haymarket and Clinical Care Options.

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Badar, T., Atallah, E., Shallis, R. et al. Survival of TP53-mutated acute myeloid leukemia patients receiving allogeneic stem cell transplantation after first induction or salvage therapy: results from the Consortium on Myeloid Malignancies and Neoplastic Diseases (COMMAND). Leukemia 37, 799–806 (2023). https://doi.org/10.1038/s41375-023-01847-7

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