Tumor suppressor p53 protein expression: prognostic significance in patients with low-risk myelodysplastic syndrome

Abstract

BackgroundAt the time of diagnosis, more than 50% of patients with myelodysplastic syndrome have a normal karyotype and are classified as having a favorable prognosis. However, these patients often show very variable clinical outcomes. Furthermore, current diagnostic tools lack the ability to look at genetic factors beyond karyotyping in order to determine the cause of this variability.ObjectiveTo evaluate the impact of p53 protein expression at diagnosis in patients with low-risk myelodysplastic syndrome.MethodsThis study enrolled 38 patients diagnosed with low-risk myelodysplastic syndrome. Clinical data were collected by reviewing medical records, and immunohistochemical p53 staining was performed on bone marrow biopsies.ResultsOf the 38 participants, 13 (34.21%) showed p53 expression in their bone marrow. At diagnosis, this group of patients also presented clinical features characteristic of a poor prognosis more often than patients who did not express p53. Furthermore, patients expressing p53 had a shorter median survival time compared to those without p53 expression.ConclusionThis study shows that the expression of p53 at diagnosis is a useful indicator of distinct clinical characteristics and laboratory profiles found in low-risk myelodysplastic syndrome patients. These data indicate that the immunohistochemical analysis of p53 may be a prognostic tool for myelodysplastic syndrome and should be used as an auxiliary test to help determine the best therapeutic choice.

Scientific comment on tumor suppressor p53 protein expression: prognostic significance in patients with low-risk myelodysplastic syndrome

“…The work published by Duarte et al in this issue of the Revista Brasileira de Hematologia e Hemoterapia validates the value of p53 in bone marrow biopsies in low-risk MDS 26 . Other studies have also shown its prognostic value in higher risk and secondary MDS.…”

SIVA, a target of p53, is downregulated in myelodysplastic syndromes

“…Deregulation of p53 is a common event in hematological malignancies. In acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS), strong p53 protein expression has been associated with TP53 mutations [4][5][6][7] and TP53 mutations have been associated with poor prognosis [8][9][10][11]. In low-risk MDS patients, high p53 protein expression is an independent predictor of transformation into AML [4].…”

Relevance of prognostic factors in the decision-making of stem cell transplantation in Myelodysplastic Syndromes

“…pressor gene is a key factor in regulating the cell cycle and tumor pathogenesis. Its overexpression is related with the presence of TP53 mutations and both have been associated with poor prognosis and shorter survival 10. The analysis by the immunohistochemistry of p53 protein has been considered a useful and easily applicable tool, having been observed in up to 34.4% of patients with low-risk MDS 11 . In addition to correlating with the presence of the mutation and indicating poor prognosis and shorter survival [12][13][14] , p53 has been identified as a parameter that can help in the indication and the outcome of HSCT [12][13][14][15] .…”