Poor 2-Year Overall Survival Observed Following HSCT in TP53-Mutant AML

Patients with TP53-mutant acute myeloid leukemia experienced poor overall survival following treatment with hematopoietic stem cell transplantation, suggesting a need for more careful patient selection, further clinical trial enrollment, and personalized treatment strategies.

Treatment with hematopoietic stem cell transplantation yielded poor overall survival (OS) in patients with TP53-mutant acute myeloid leukemia (AML), highlighting the need for more sophisticated patient selection, further enrollment on clinical trials, and more personalized treatment approaches, according to findings from a poster presented at the 2022 Tandem Meeting.

At a median follow up of 2 years in 5 studies, the OS rate was 15.3% (95% CI, 0.05-0.28; I2 = 88%) among patients with TP53-mutant AML (n = 451). The pooled 2-year OS rate was 17.2% (95% CI, 0.05-0.34; i2 = 93%) in 3 studies (n = 404). Moreover, the pooled 2-year progression-free survival rate was 12% (95% CI, 0.02-0.34; I2 = 94%; n = 241). Investigators also reported a pooled relapse rate of 79.1% (95% CI, 0.57-0.95; I2 = 90%; n = 258) with a median of 2 years of follow up and a pooled 2-year relapse rate of 85.7% (95% CI, 0.55-1.0; I2 = 94%; n = 209). A single study reported on nonrelapse mortality, with a 3-year rate of 32.5%.

“Novel therapeutic strategies based on disease biology are needed in prospective, exploratory clinical trials in both transplant and non-transplant settings,” the investigators wrote.

Investigators noted that TP53 mutations are associated with a poor prognosis and resistance to chemotherapy across numerous hematologic malignancies. As the mutation has been identified in up to 20% of patients with AML and is typically reported alongside a 2-year OS rate of 10%, investigators conducted the systemic review and meta-analysis to assess outcomes with HSCT in this population.

A total of 6 out of 387 screened studies were included in the analysis. The review included a total of 460 patients with TP53-mutant AML. The median patient age was 55 years (range, 19-90). The median follow-up time for all studies was 52.5 months (range, 0.9-407.3).

Reference

Shahzad M, Chaudhary SG, Tariq E, et al. Outcomes with allogenic hematopoietic stem cell transplantation in TP53-mutated acute myeloid leukemia: a systematic review and meta-analysis. Presented at: 2022 Tandem Meeting; April 23-26, 2022; Salt Lake City, UT. Abstract 146.