Scientific comment on tumor suppressor p53 protein expression: prognostic significance in patients with low-risk myelodysplastic syndrome

Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal hematopoietic neoplasms, characterized by dysplastic findings with variable degree of bone marrow failure and proliferation of blast cells.1 It is the most common neoplastic disease of the bone marrow, with an estimated incidence of 1.3–5 per 100,000 people annually, and reaching 36 per 100,000 in patients aged 80 years or over. Risk factors include: advanced age (MDS de novo, corresponding to 90% of cases), previous exposure to chemotherapy or radiation therapy (therapy-related MDS), aplastic anemia and constitutional diseases, particularly those with abnormal DNA repair, such as Fanconi anemia.2 The clinical course is highly variable with survival ranging from several years to a few months and variable risk of progression to acute myeloid leukemia (AML). Because of this heterogeneity, the study of prognostic factors is very important. Factors related to the individual (such as performance status, co-morbidities, age and nutritional status), biological (severity of cytopenias, transfusion need, cytogenetic abnormalities, percentage of blasts, bone marrow fibrosis, primary or secondary disease) and social (access to health care and medications) impact the survival. Themodelsmost commonly used in prognostic score for MDS de novo, such as the International Prognostic Scoring System (IPSS), the WHO Prognostic Scoring System (WPSS), and the Revised International Prognostic Scoring System (IPSS-R) basically use biological variables, obtained from the study of blood cell counts (cytopenias), per-