Relationship between p53 expression and prognosis of myelodysplastic syndrome treated with azacitidine

Abstract

We previously demonstrated that a CD13/CD33 ratio low (< 1) and high (≥ 2) was associated with shorter survival in patients with myelodysplastic syndromes (MDS) treated with azacitidine (AZA). Previous studies also showed the negative impact of TP53 mutations on patient outcomes. The aim of the study is to investigate the relationship between a p53 expression, CD13/CD33 ratio, and the outcomes of MDS patients treated with AZA. The relationship between the p53 expression, CD13/CD33 ratio in blast cells, and outcomes of 121 MDS patients treated with AZA was examined. In patients with CD13/CD33 ratio low and high, there was no significant difference in survival between p53-positive and p53-negative patients. However, in the patients with 1 ≤ CD13/CD33 ratio < 2, p53 positivity correlated with higher serum LDH levels. Poorer risk status according to cytogenetics was more frequently observed in p53-positive patients than in p53-negative patients. The rates of progressive disease and failure after 4 cycles of AZA were higher in p53-positive patients than in p53-negative patients. Univariate and multivariate analyses confirmed that higher serum LDH levels and p53 positivity were independent adverse prognostic factors for prognosis. A Kaplan-Meier analysis revealed the potential of p53 expression as a prognostic factor in patients with 1 ≤ CD13/CD33 ratio < 2 and that it correlated with shorter survival and acute myeloid leukemia (AML) progression. The present study showed that p53 expression is an independent risk factor for shorter overall survival and AML progression in MDS patients with 1 ≤ CD13/CD33 ratio < 2.