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TP53 mutations in newly diagnosed acute myeloid leukemia: Clinicomolecular characteristics, response to therapy, and outcomes
Author(s) -
Kadia Tapan M.,
Jain Preetesh,
Ravandi Farhad,
GarciaManero Guillermo,
Andreef Michael,
Takahashi Koichi,
Borthakur Gautam,
Jabbour Elias,
Konopleva Marina,
Daver Naval G.,
Dinardo Courtney,
Pierce Sherry,
KanagalShamanna Rashmi,
Patel Keyur,
Estrov Zeev,
Cortes Jorge,
Kantarjian Hagop M.
Publication year - 2016
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30203
Subject(s) - medicine , myeloid leukemia , oncology , myeloid
BACKGROUND Mutations in the tumor protein 53 ( TP53 ) gene predict a poor prognosis in patients with acute myeloid leukemia (AML). METHODS Peripheral blood or bone marrow samples from 293 patients with newly diagnosed AML were analyzed with targeted, amplicon‐based, next‐generation sequencing‐based mutation analysis. RESULTS TP53 mutations were identified in 53 patients (18%; 45 were missense mutations). In 13 of the 53 patients, the most common pattern of amino acid substitution was a substitution of arginine to histidine on different codons. The clinical characteristics, pattern of mutations, response to different therapies, and outcomes of patients with AML‐ TP53 –mutated (n = 53) versus wild‐type TP53 (n = 240) were compared. TP53 mutations were significantly more likely in patients who had a complex karyotype; abnormalities of chromosome 5, 7, and 17; and therapy‐related AML. Patients who had TP53 ‐mutated AML had significantly lower incidence of mutations in Fms‐like tyrosine kinase 3 ( FLT3 ), rat sarcoma ( RAS ), and nucleophosmin ( NPM1 ) and higher incidence of coexisting MPL mutations compared with those who had wild type TP53 . The distribution of TP53 mutations was equal for both age groups (ages <60 years vs ≥60 years). TP53 ‐mutated AML was associated with a lower complete remission rate (41% vs 57%; P = .04), a significantly inferior complete remission duration (at 2 years: 30% vs 55%; P = .001), and overall survival (at 2 years: 9% vs 24%; P ≤ .0001) irrespective of age or the type of treatment received (high‐intensity vs low‐intensity chemotherapy). CONCLUSIONS The type of treatment received did not improve outcomes in younger or older patients with TP53 ‐mutated AML. These data suggest that novel therapies are needed to improve the outcome of patients with AML who have TP53 mutations. Cancer 2016;122:3484–3491 . © 2016 American Cancer Society