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The International Consensus Classification questions the blast threshold between MDS and AML. In this study, we assess the distinction between MDS and AML for 76 patients with\n                    <jats:italic>TP53<\/jats:italic>\n                    aberrations. We observed no significant differences between MDS and AML regarding\n                    <jats:italic>TP53<\/jats:italic>\n                    genomics. Median overall survival (OS) was 223 days for the entire group, but prognostic discrimination within subgroups showed the most inferior OS (46 days) for AML with multihit allelic state plus\n                    <jats:italic>TP53<\/jats:italic>\n                    variant allele frequency (VAF) &gt; 50%. In multivariate analysis, unadjusted Cox models revealed the following variables as independent risk factors for mortality: AML (vs. MDS) (hazard ratio [HR]: 2.50, confidence interval [CI]: 1.4\u20134.4,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.001), complex karyotype (HR: 3.00, CI: 1.4\u20136.1,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.003), multihit status (HR: 2.30, CI 1.3\u20134.2,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.005), and absence of hematopoietic cell transplant (HCT) (HR: 3.90, CI: 1.8\u20138.9,\n                    <jats:italic>p<\/jats:italic>\n                    = 0.0009). Clonal dynamic modeling showed a significant reduction in\n                    <jats:italic>TP53<\/jats:italic>\n                    VAF with front\u2010line hypomethylating agents. These findings clarify the impact of specific covariates on outcomes of\n                    <jats:italic>TP53<\/jats:italic>\n                    \u2010aberrant myeloid neoplasms, irrespective of the diagnosis of MDS versus AML, and may influence HCT decisions.\n                  <\/jats:p>","DOI":"10.1002\/jha2.791","type":"journal-article","created":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T04:46:49Z","timestamp":1694407609000},"page":"1059-1070","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Prognostic heterogeneity and clonal dynamics within distinct subgroups of myelodysplastic syndrome and acute myeloid leukemia with\n                    <i>TP53<\/i>\n                    disruptions"],"prefix":"10.1002","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8208-1902","authenticated-orcid":false,"given":"Shyam A.","family":"Patel","sequence":"first","affiliation":[{"name":"Division of 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Department of Medicine UMass Memorial Medical Center, UMass Chan Medical School  Worcester Massachusetts United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6480-8290","authenticated-orcid":false,"given":"Asiri","family":"Ediriwickrema","sequence":"additional","affiliation":[{"name":"Institute for Stem Cell Biology &amp; Regenerative Medicine; Division of Hematology, Department of Medicine Stanford University  Stanford California United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Tanenbaum","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Medicine UMass Memorial Medical Center, UMass Chan Medical School  Worcester Massachusetts United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lloyd","family":"Hutchinson","sequence":"additional","affiliation":[{"name":"Department of Pathology UMass Memorial Medical 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J.","family":"Gillis\u2010Smith","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Medicine UMass Memorial Medical Center, UMass Chan Medical School  Worcester Massachusetts United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakiko","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Medicine UMass Memorial Medical Center, UMass Chan Medical School  Worcester Massachusetts United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salwa","family":"Khedr","sequence":"additional","affiliation":[{"name":"Department of Pathology UMass Memorial Medical Center, UMass Chan Medical School  Worcester Massachusetts United 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