Evaluating the prognostic value of TP53 mutations in acute leukemia: a comprehensive retrospective study from a tertiary care hospital.

Abstract

Background: Acute leukemia with gene mutations, particularly TP53, is associated with poor prognosis, yet their impact in middle-aged and elderly patients remains insufficiently explored. This study evaluated the prevalence and prognostic significance of TP53 mutations in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL).

Methods: This retrospective cohort study included 93 adult patients diagnosed with AML (n = 50) or ALL (n = 43) between January 2013 and December 2023. Clinical, laboratory, and molecular data were collected. Kaplan-Meier survival analysis, Cox proportional hazards regression, and comparative descriptive statistics were used to analyze the impact of TP53 mutations on patient prognosis.

Results: TP53 mutations were detected in 16 patients (17.2%). The median age was 56.50 years for TP53^mut patients and 56.00 years for TP53^wt patients. TP53 mutations were associated with significantly poorer overall survival (OS), with a median OS of 16.50 months in TP53^mut patients compared to 39 months in TP53^wt patients (P = 0.001). In AML patients, TP53 mutations were linked to a median OS of 14.50 months versus 34.50 months in TP53^wt patients (P = 0.015). In ALL patients, the median OS was 22 months for TP53^mut patients compared to 46 months for TP53^wt patients (P = 0.042). Multivariate analyses identified age ≥ 60 years as a significant predictor of poor OS (P < 0.05).

Conclusion: This study shows that TP53 mutations significantly worsen the prognosis of acute leukemia. Routine TP53 mutation screening should be integrated into clinical practice to refine risk stratification and guide treatment, while prospective studies are needed to validate these findings and explore targeted therapies.