High p53 protein expression in therapy-related myeloid neoplasms is associated with adverse karyotype and poor outcome

Arjen H. G. Cleven, Valentina Nardi, Chi Young Ok, Maitrayee Goswami, Paola Dal Cin, Zongli Zheng, A. John Lafrate, Myrurgia A. Abdul Hamid, Sa A. Wang, Robert P. Hasserjian*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Identification of p53-positive cells by immunohistochemistry in bone marrow from primary myelodysplastic syndrome patients correlates with the presence of TP53 mutations and poor prognosis. Mutations in the tumor suppressor gene TP53 are more frequent in therapy-related acute myeloid leukemia and myelodysplastic syndrome than in de novo disease, but the role of p53 immunohistochemistry in the therapy-related setting has not been specifically investigated. We studied p53 protein immunoreactivity in bone marrow biopsies of therapy-related myeloid neoplasms and correlated protein expression with TP53 mutation status, clinicopathologic features and outcome. We first studied 32 patients with therapy-related acute myeloid leukemia and 63 patients with therapy-related myelodysplastic syndrome/chronic myelomonocytic leukemia from one institution and then validated our results in a separate group of 32 patients with therapy-related acute myeloid leukemia and 56 patients with therapy-related myelodysplastic syndrome from a different institution. Strong p53 immunostaining in > 1% of bone marrow cells was highly predictive of a TP53 gene mutation (P= 1% p53 strongly positive cells was associated with poorer overall and disease-specific survival, particularly in the subset of patients treated with stem-cell transplantation. In a multivariable Cox regression model, the presence of >= 1% p53 strongly expressing cells was an independent prognostic marker for overall survival in both cohorts, with hazard ratios of 3.434 (CI: 1.751-6.735, P
Original languageEnglish
Pages (from-to)552-563
JournalModern Pathology
Issue number4
Publication statusPublished - Apr 2015

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