Patients with TP53 -Mutated Acute Myeloid Leukemia Receiving Intensive Induction Therapy Have Superior Outcomes Due to a Higher Rate of Salvage Therapy: A Single Institution, Retrospective Study.

Autor: Sumransub N; Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA., Steinwand GK; M Health Fairview, Department of Pharmacy, University of Minnesota Medical Center, Minneapolis, MN 55455, USA., Cordner K; Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA., Lee Y; Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.; Bioinformatics and Computational Biology Graduate Program, University of Minnesota, Minneapolis, MN 55455, USA., Cao Q; Biostatistics and Informatics, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN 55455, USA., Allred J; Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA., Bachanova V; Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA., Juckett M; Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA., Eckfeldt C; Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA., Maakaron JE; Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA., Tracy SI; Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA., Ramesh V; Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA., Nelson AC; Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN 55455, USA., Yohe S; Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN 55455, USA., Sachs Z; Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.; Bioinformatics and Computational Biology Graduate Program, University of Minnesota, Minneapolis, MN 55455, USA.; Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA.
Jazyk: angličtina
Zdroj: Cancers [Cancers (Basel)] 2024 Aug 07; Vol. 16 (16). Date of Electronic Publication: 2024 Aug 07.
DOI: 10.3390/cancers16162784
Abstrakt: Background: TP53 mutations ( TP53 m) define the most treatment-refractory acute myeloid leukemia (AML) subtype. Optimal treatment approaches have not been established in this setting. We reviewed our institutional experience to identify therapy sequencing, treatment response, and survival patterns in these patients.
Methods: This study was a single-center, retrospective cohort analysis.
Results: Our cohort includes 86 TP53 m and 337 TP53 wild-type ( TP53 wt) adult AML patients. TP53 m AML patients presented with lower bone marrow and peripheral blasts; none presented with hyperleukocytosis. Patients who received intensive treatment up front demonstrated superior overall survival (OS) over those receiving first-line non-intensive therapy (2-year OS 22% versus 7%; p = 0.02). However, the complete remission (CR) rates among the first-line intensive and non-intensive therapy groups were comparable (21.9% and 29.4%, respectively, p = 0.49). The improved OS is therefore attributed to superior cumulative CR in the intensive group. First-line intensively treated patients were more likely to receive and respond to salvage, leading to a cumulative CR rate of 65.7% (versus 29.4%, p = 0.003). Achieving CR at any point is strongly associated with superior survival outcomes with 2-year OS of 31% versus 0% for those not achieving CR ever ( p < 0.01).
Conclusions: We find that TP53 m AML rarely presents with oncological emergencies, suggesting that clinical trial enrollment is feasible in this group. Additionally, in our cohort, intensive induction therapies lead to superior survival outcomes attributed to successful salvage therapy. These data suggest that strategic therapy sequencing and salvage therapy may be important in optimizing outcomes for TP53 m AML patients.
Databáze: MEDLINE
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