Changes in the Management of TP53-Mutant AML

Melhem Solh, MD, Northside Hospital, discusses how the standard of care for patients with myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) with the tumor protein 53 (TP53) gene mutation has changed over the past decade.

Research done by the Blood Marrow Transplant Program at Northside Hospital examined the outcomes of patients with AML and MDS who have a TP53 gene mutation as well as the post-transplant outcomes of those patients as they tend to have very poor outcomes.

According to Solh, this patient population has been challenging as they have responded poorly to chemotherapy and often relapse quickly.

Transcription:

0:08 | This has been a very challenging population of patients because we know they've done poorly with chemotherapy. They tend to be refracted or have very quick relapses. If a patient has TP53 deletion 17 AML, they are not eligible for transplant for 1 reason or the other, and they are not going to do well. Even with transplant, they still don't do too well compared to other subtypes of AML. The question is, using the drugs we have available now to put them in a deeper remission before transplant, would that translate into a better outcome?

0:47 | Now, unfortunately, we didn't have the amount of deep data on those patients and our analysis because some of them go back 6 or 7 years ago, before we're able to collect that type of data. That would be one question to answer. Do you really need to get as deep of a response to help improve, and would the transplant matter at that point in this specific subgroup? We know it matters in general to get somebody MRD negative.

1:13 | The other thing, using post-transplant maintenance, there's a tendency to try to put patients on a hypomethylating agent. There are studies going on to do a hypometh plus venetoclax [Venclexta] for high-risk patients, which I'd imagine this group would fall into. The answer for would make a difference in their outcomes is that we have to wait for the study to decide.