Graphical summary of interplay of TP53 state, blast count, and complex karyotype in MDS and AML. (A) Summary of the general trends of the frequency of TP53 allelic state (single hit vs double hit) and outcome of patients in the analyzed subgroups. MDS cases with <5% blasts clearly separate from MDS cases with ≥5% blasts and from AML cases by the predominance of TP53 single hit and by being the only subgroup in which a complex karyotype showed an independent adverse impact on OS. The remaining subgroups (MDS with ≥5% but <10% blasts; MDS with ≥10% but <20% blasts; and AML) display a number of similarities, with TP53 double hit found at high frequencies and only TP53 alterations but not a complex karyotype independently influencing OS. Please note that the graphic indicates a general trend but that MDS with ≥10% but <20% blasts actually showed a higher percentage of TP53 double hit compared with AML. Furthermore, a decrease in survival with increasing blast count was observed. (B) Interplay of TP53 state, blast count, and complex karyotype on OS. In the total cohort, TP53 state, in particular the double hit, was the strongest prognostic factor; however, also the blast count influenced OS independent of TP53 allelic state. By contrast, the influence of the presence of a complex karyotype on OS seems to be highly dependent on blast count and TP53 allelic state.