TP53 Mutations in AML Patients Are Associated with Dismal Clinical Outcome Irrespective of Frontline Induction Regimen and Allogeneic Hematopoietic Cell Transplantation.

mutations are associated with extremely poor outcomes in acute myeloid leukemia (AML). The outcomes of patients with -mutated () AML after different frontline treatment modalities are not well established. Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative procedure for AML; however, long-term outcomes among patients with AML after allo-HCT are dismal, and the benefit of allo-HCT remains controversial. We sought to evaluate the outcomes of patients with AML after treatment with different frontline induction therapies and allo-HCT. A total of 113 patients with AML were retrospectively evaluated. Patients with AML who received intensive or azacitidine-venetoclax induction had higher complete remission rates compared to patients treated with other hypomethylating-agent-based induction regimens. However, OS and EFS were not significantly different among the induction regimen groups. Allo-HCT was associated with improved OS and EFS among patients with AML; however, allo-HCT was not significantly associated with improved OS or EFS in time-dependent or landmark analysis. While the outcomes of all patients were generally poor irrespective of therapeutic strategy, transplanted patients with lower variant allele frequency (VAF) at the time of diagnosis had superior outcomes compared to transplanted patients with higher VAF. Our study provides further evidence that the current standards of care for AML confer limited therapeutic benefit to patients with mutations.