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3218 PPM1D Somatic Mutations in Myeloid Neoplasms: Clinical Profile, Clonal Characteristics and Impact of Concurrent Somatic TP53 Mutations

Program: Oral and Poster Abstracts
Session: 637. Myelodysplastic Syndromes: Clinical and Epidemiological: Poster II
Hematology Disease Topics & Pathways:
MDS, Chronic Myeloid Malignancies, Diseases, Therapy sequence, Myeloid Malignancies
Sunday, December 8, 2024, 6:00 PM-8:00 PM

Talha Badar, MD1, Mobachir El Kettani, MD2*, Kashish J. Shah, MBBS2*, Terra L. Lasho, PhD3, Yael Kusne, MD, PhD4, Christy M Finke3*, James M. Foran, MD5, Mohamed A. Kharfan-Dabaja, MD, MBA6, Hemant S. Murthy, MD2, Yao-Shan Fan, MD, PhD2, Liuyan Jiang, MD7*, Naseema Gangat, MBBS3, Abhishek A. Mangaonkar, MBBS8, Aref Al-Kali, MD3,8,9, Ludovica Marando, MD, PhD9, Ayalew Tefferi, MD3, Rong He, MD10, David Viswanatha, MD11, Mark R. Litzow, MD3 and Mrinal M. Patnaik, MD, MBBS8

1Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, FL
2Mayo Clinic, Jacksonville, FL
3Division of Hematology, Mayo Clinic, Rochester, MN
4Mayo Clinic, Phoenix, AZ
5Division of Hematology & Medical Oncology, Mayo Clinic, Jacksonville, FL
6Department of Hematology/Oncology, Mayo Clinic, Jacksonville, FL
7Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science, Jacksonville
8Mayo Clinic, Rochester, MN
9Mayo Clinic, Rochester
10Division of Hematopathology, Mayo Clinic, Rochester, MN
11Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester

Background:

Therapy-related myeloid neoplasms (t-MN) occur after exposure to DNA-damaging agents including cytotoxic chemo and radiation therapy and are associated with dismal outcomes. TP53 and PPM1D (protein phosphatase Mn2+/Mg2+-dependent 1D) mutations (MT) disrupt the DNA damage response and repair (DDR) pathway, are often co-mutated (25-35%), and although enriched in t-MN (20%), can also be seen in age-related clonal hematopoiesis (CH) (5-10%). While progressive genomic instability with biallelic inactivation has been described as a mechanism of MN progression with TP53 MT, similar mechanisms remain to be elucidated for PPM1D MT. We conducted this study to assess the clinical phenotype and outcomes of TP53 and PPM1D co-mutated (PPM1DTP53m) versus PPM1D MT and wild type TP53 (PPM1DTP53wt) CH and MN.

Methods:

After approval from the Mayo Clinic IRB, the CH and MN databases were queried and 119 pts with PPM1D MT (CH= 26, clonal cytopenia of unknown significance [CCUS]= 64, myelodysplastic syndrome [MDS]=16, myeloproliferative neoplasm [MPN]=8, acute myeloid leukemia [AML]= 5) were identified. We analyzed baseline characteristics, karyotypic changes, somatic mutations, and survival outcomes between the PPM1DTP53m (n= 22) and PPM1DTP53wt (n= 97) groups (gp).

Results:

Baseline characteristics

The median age in years (yrs) was 68.5 (range [R], 43-89) and 71 (R,30-92) in the PPM1DTP53m and PPM1DTP53wt gp (p= 0.65). 22% vs 18% (p=0.78), 58% vs 32% (p=0.03), 9% vs 32% (p=0.01), 7% vs 4.5% (p=>0.99) and 3% vs 14% (p=0.07) pts met criteria for CH, CCUS, MDS, MPN and AML in the PPM1DTP53wt and PPM1DTP53m gp, respectively. Similarly, 19% vs 18% (p=>0.99), 47% vs 32% (p=0.23), 7% vs 36% (p=0.001), 2% vs 0% (p=>0.99) and 2% vs 14% (p=0.04) of pts met criteria for t-CH, t-CCUS, t-MDS, t-MPN and t-AML in the PPM1DTP53wt and PPM1DTP53m gp, respectively. All PPM1D variants were truncating, located in exon 6 of the gene, with median variant allele frequency (VAF) (8% [R,1-64] vs 5.5% [R,2-24], p= 0.10) and number of PPM1D MT (1 [R,1-5] vs 1 [R, 1-3], p=>0.99) being similar between the two gp. While proportion of pts with t-MN were similar between the two gps (77% vs 86%, p= 0.40), cytogenetic (CG) abnormalities (67% vs 31%, p= 0.006), including monosomies (28% vs 2%, p= <0.001) and complex CG (53% vs 4%, p= <0.001) were more frequent in PPM1DTP53m gp compared to PPM1DTP53wt gp, respectively. The median TP53 MT VAF was 14% (R, 1-14); 50% had multi-hit TP53 MT.

Somatic mutations in PPM1D MT myeloid neoplasm with and without TP53 MT

Somatic co-mutations excluding TP53 were seen in 71% of pts; 73.5% in PPM1DTP53wt and 59% in PPM1DTP53m gp (p= 0.20). Apart from CBL (0% vs 9%,p=0.03), MT involving DNMT3A (20% vs 14%, p= 0.56), TET2 (15% vs. 14%, p= >0.99), IDH1 (6% vs 19%, p= 0.07), splicing factors (8% vs 14%, p=0.08), ASXL1 (11% vs 4.5%, p=0.46), and JAK2 (9% vs 0%,p=0.20) were comparable between PPM1DTP53wt and PPM1DTP53m gps, respectively. The proportion of pts with ≥ 2 somatic co-mutations excluding TP53 MT were numerically higher in PPM1DTP53wt gp (43%) compared to PPM1DTP53m gp (23%) (p= 0.09). In the PPM1DTP53wt gp, other somatic driver mutations included RUNX1 (n= 7 [7%]; CH [n=1], CCUS [n=2], MDS [n=3], MPN [n=1]), NRAS (n=1 [1%]; CCUS), BCOR (n=1 [1%]; CCUS), and PTPN11 (n=1 [1%]; CCUS).

Leukemic transformation and survival

With a median follow up of 6.43 months (mo) (R, 0.23-36.4), median overall survival (mOS) in mo among high-risk MDS/AML (16.4 vs 15.0, p= 0.66) and CHIP/CCUS pts (35.79 vs 26.28, p= 0.93) was similar between PPM1DTP53wt and PPM1DTP53m gps, respectively. CHIP/CCUS pts harboring multiple vs single PPM1D MT had an inferior mOS (23.9 vs 36.7 mo, p= 0.05). Three (2.5%) MDS pts underwent AML transformation; 1 (1%) and 2 (10%) in PPM1DTP53wt and PPM1DTP53m gp, respectively (p= 0.07).

Conclusions

In our study, 18% of pts had concurrent TP53 and PPM1D MT (82% t-MN), with the PPM1DTP53wt genotype being more frequent in CCUS, while the PPM1DTP53m genotype was more frequent in MN. The PPM1DTP53m genotype had a higher frequency of CG abnormalities, including complex CG. Survival outcome was inferior and comparable in PPM1D MT MN with or without TP53 MT. While 73.5 % of the PPM1DTP53wt gp had somatic driver MT and 31% had karyotypic abnormalities, 22% had no additional MT or CG changes (all CH/CCUS), underscoring the need to understand how PPM1D MT contribute to hematopoietic dysfunction and MN.

Disclosures: Badar: Morphosys: Other: Advisory Board; pfizer: Other: Advisory board; Takeda: Other: advisory board . Kharfan-Dabaja: Kite Pharma: Honoraria; Pharmacyclics: Research Funding; Novartis: Research Funding; Bristol Myers Squibb: Research Funding. Murthy: CRISPR therapeutics,: Consultancy, Membership on an entity's Board of Directors or advisory committees; Senti Bioscience: Consultancy, Membership on an entity's Board of Directors or advisory committees; Jazz pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Marker Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bristol Myers Squibb: Consultancy, Membership on an entity's Board of Directors or advisory committees; Incyte: Consultancy, Membership on an entity's Board of Directors or advisory committees. Gangat: DISC Medicine: Consultancy, Other: Advisory Board ; Agios: Other: Advisory Board. Mangaonkar: BMS: Research Funding; Incyte: Research Funding; Novartis: Research Funding. Litzow: Abbvie: Research Funding; Amgen: Research Funding, Speakers Bureau; Actinium: Research Funding; Astellas: Research Funding; Pluristem: Research Funding; Sanofi: Research Funding; Beigene: Speakers Bureau; Biosight: Other: Data Safety Monitoring Committee. Patnaik: Astra Zeneca: Membership on an entity's Board of Directors or advisory committees; Kura Oncology: Research Funding; Epigenetix: Research Funding; Solu therapeutics: Research Funding; Polaris: Research Funding; StemLine: Research Funding.

*signifies non-member of ASH