Benefit of AlloSCT for Patients With TP53 Mutations and Acute Myeloid Leukemia/Myelodysplastic Syndromes

At an onsite debate at the 2022 Lymphoma, Leukemia & Myeloma Congress in New York, Koen W van Besien, MD, University Hospitals Seidman Cancer Center, Cleveland, OH, argues that patients with acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS) and TP53 mutations should undergo allogeneic stem cell transplantation. 

Transcript:

I'm Dr van Besien, from the UH Seidman Cancer Center in Cleveland, Ohio, and the Wesley Center for Immunotherapy. By trade, I'm a stem cell transplant physician and hematologist, and I'm attending this meeting now for the 10th time. I was asked to talk about the role of transplantation in patients with TP53 (p53) mutated acute myelogenous leukemia/MDS. It was a debate, and I was asked to take the “pro” side, but I think it's in general important to think of transplant for our patients with acute [myeloid] leukemia. It's a difficult procedure, but it's often the only curative procedure.

I think it's important to consider it in every patient. It's not for every patient, but it should be considered for every patient. Have them talk to a transplanter, because without transplant, many times you will resort to palliative therapy or temporary therapy, whereas transplant gives them a chance for cure.

P53 mutated AML is probably the most difficult to treat form of AML. Many patients fail to achieve remissions. Many patients relapse again after remission. And I made the point, based on very strong and recent data, that transplant can cure a subset of these patients, and that it's better to get the transplant, if it's possible, if it's feasible, if age, comorbidities, health and remission status allow it.

There are a number of predictors for outcome that have been identified. The most important one is the presence of a complex karyotype in addition to the p53 mutation. The presence of such a complex karyotype really predicts for a high relapse rate even after transplant. But I made the point that one cannot entirely rely on such predictors or such correlations because there are exceptions to the rule, and I showed the example of a patient of mine who had really, by all usual predictors, an awful prognosis, and we decided to transplant him anyway, in part because we did not have access to those predictors back in 2015, and he's doing very well now, 7 years later.

For those hematologists who are not transplant physicians, but who take care of leukemia patients, we have a lot of progress to make in the p53 mutated AML, but transplantation should be part of that process.

Source:

van Besien KW. Debate: Should AML or MDS patients with TP53 Mutations Undergo Allogeneic Stem Cell Transplantation: Yes. Presented at Lymphoma, Leukemia & Myeloma Congress; October 18-22, 2022. New York, NY