Acute Myeloid Leukemia and Myelodysplastic Neoplasms: Clinical Implications of Myelodysplasia-Related Genes Mutations and TP53 Aberrations

Purpose The fifth World Health Organization (WHO) classification (2022 WHO) and International Consensus Classification (ICC) of myeloid neoplasms have recently been published. We reclassified patients according to the revised classification and analyzed their prognosis to confirm the clinical utility of the new classifications. Methods We included 101 adult patients, including 77 with acute myeloid leukemia (AML) and 24 with myelodysplastic neoplasms (MDS), who underwent bone marrow aspiration and next-generation sequencing (NGS) between August 2019 and July 2023. We reclassified patients according to the revised criteria, then examined the differences and analyzed the prognosis using survival analysis. Results According to the 2022 WHO and ICC, 23 (29.9%) patients and 32 (41.6%) patients were reclassified into different groups, respectively, due to the addition of myelodysplasia-related (MR) gene mutations to the diagnostic criteria or the addition of new entities associated with TP53 mutations. The median overall survival (OS) of patients with AML and MR gene mutations was shorter than those of other AML group; however, the difference was not significant. Patients with AML and TP53 mutation had a significantly shorter OS than the other AML group ( p  = 0.0014, median OS 2.3 vs 10.3 months). They also had significantly shorter OS than the AML and MR mutation group ( p  = 0.002, median OS 2.3 vs 9.6 months). Conclusion The revised classifications allow for more detailed categorization based on genetic abnormalities, which may be helpful in predicting prognosis. AML with TP53 mutations is a new ICC category that has shown high prognostic significance in a small number of cases.