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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) offers a potential cure, but outcomes are suboptimal and risk stratification remains challenging.\u00a0This multi-center, retrospective study analyzed 66 patients with TP53-mutated AML\/MDS who underwent allo-HSCT. The study endpoints included overall survival (OS), progression-free survival (PFS), and cumulative incidence of relapse (CIR), non-relapse mortality (NRM), and Graft-versus-host disease-free, relapse-free survival (GRFS).\u00a0After median 1054-day follow-up, 3-year rates for OS, PFS, CIR, NRM, and GRFS were 47.2%, 39.7%, 37.3%, 23%, and 37.4%, respectively. Survival did not differ between AML and MDS. Univariate analysis showed that &lt;\u20092 somatic myeloid co-mutations predicted inferior OS (3-y OS: 32% vs. 65.9%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02) and PFS (27.6% vs. 59.1%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.01). Age\u2009&gt;\u200950 years adversely affected PFS, and complex karyotype showed a negative trend. Multivariate analysis found no independent factors, likely due to sample size and collinearity. A combined risk factor analysis revealed that patients with \u2265\u20091 adverse factor (either co-mutations\u2009&lt;\u20092 or complex karyotype) had significantly worse OS (3-y OS: 72.6% vs. 37.2%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.04) and PFS (3-y PFS: 67.7% vs. 28.9%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02) compared to those with neither risk factor.\u00a0In patients with TP53-mutated AML\/MDS undergoing allo-HSCT, a low myeloid co-mutation burden (&lt;\u20092) is strongly associated with poor outcomes. A composite model integrating co-mutation burden with karyotype may assist in post-transplant risk stratification, offering a practical supplementary parameter when TP53 allelic status is uncertain. This finding requires validation in larger prospective studies.\n                  <\/jats:p>","DOI":"10.1007\/s00277-026-06895-4","type":"journal-article","created":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T06:32:30Z","timestamp":1772865150000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The prognostic impact of myeloid co-mutation burden in TP53-mutated AML\/MDS after allogeneic stem cell transplantation: a multicenter retrospective analysis"],"prefix":"10.1007","volume":"105","author":[{"given":"Yao","family":"Sun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanshan","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai","family":"Yi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Na","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangwei","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuoqing","family":"Qiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daihong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liping","family":"Dou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liangding","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,7]]},"reference":[{"issue":"30","key":"6895_CR1","doi-asserted-by":"publisher","first-page":"3627","DOI":"10.1200\/jco.2016.67.3616","volume":"34","author":"MG Della Porta","year":"2016","unstructured":"Della Porta MG, Gall\u00ec A, Bacigalupo A, Zibellini S, Bernardi M, Rizzo E, Allione B, van Lint MT, Pioltelli P, Marenco P, Bosi A, Voso MT, Sica S, Cuzzola M, Angelucci E, Rossi M, Ubezio M, Malovini A, Limongelli I, Ferretti VV, Spinelli O, Tresoldi C, Pozzi S, Luchetti S, Pezzetti L, Catrical\u00e0 S, Milanesi C, Riva A, Bruno B, Ciceri F, Bonifazi F, Bellazzi R, Papaemmanuil E, Santoro A, Alessandrino EP, Rambaldi A, Cazzola M (2016) Clinical effects of driver somatic mutations on the outcomes of patients with myelodysplastic syndromes treated with allogeneic hematopoietic stem-cell transplantation. 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