Summary of proposed recommendations regarding pursuit of allo-HCT in patients with TP53-mutated MDS/AML according to disease and patient characteristics
| Disease characteristics . | Patient characteristics . | Offer allo-HCT? . | Comments . |
|---|---|---|---|
| Monoallelic TP53 mutation without complex karyotype | Fit for allo-HCT | Yes, if both criteria were met | Standard fitness criteria applied. |
| Biallelic TP53 loss ± complex karyotype | KPS ≥ 90 and HCT-CI < 4∗ | Consider | ∗Score intended as provisional guidance rather than absolute threshold. Consider the use of alternative nonrelapse mortality scoring systems.70,71 Donor options may modify risk assessment (eg, we are less likely to pursue allo-HCT in an older patient with these characteristics if only alternative donor is available). Must clearly discuss risks, benefits, and expectations regarding posttransplant prognosis. |
| Biallelic TP53 loss ± complex karyotype | KPS < 90 HCT-CI ≥ 4∗ | No | Consider referral for second opinion regarding allo-HCT. |
| Disease characteristics . | Patient characteristics . | Offer allo-HCT? . | Comments . |
|---|---|---|---|
| Monoallelic TP53 mutation without complex karyotype | Fit for allo-HCT | Yes, if both criteria were met | Standard fitness criteria applied. |
| Biallelic TP53 loss ± complex karyotype | KPS ≥ 90 and HCT-CI < 4∗ | Consider | ∗Score intended as provisional guidance rather than absolute threshold. Consider the use of alternative nonrelapse mortality scoring systems.70,71 Donor options may modify risk assessment (eg, we are less likely to pursue allo-HCT in an older patient with these characteristics if only alternative donor is available). Must clearly discuss risks, benefits, and expectations regarding posttransplant prognosis. |
| Biallelic TP53 loss ± complex karyotype | KPS < 90 HCT-CI ≥ 4∗ | No | Consider referral for second opinion regarding allo-HCT. |