OS of patients with TP53 alteration in the total AML and MDS cohorts, and suggestion of a diagnostic algorithm. (A-B) In patients with (A) AML and (B) MDS, the OS was analyzed for patients with TP53 sh (red line), TP53 dh (green line), and without TP53alts (blue line; no hit). In (C) and (D), OS was analyzed in more detail for patients with TP53 mut-only (purple line), with TP53 del-only (dark gray line), with cnLOH-only (light gray line), with mut + del (red line), with mut + cnLOH (light red line), with ≥2 mut-only (orange line), and in patients with no hit (blue line). The P values denote the significance of the respective alteration in comparison to no hit. Clinical data were available for 717 patients with AML and 737 patients with MDS. (E,F) Recommendation of TP53 analysis for AML and MDS subgroups and suggestion of a diagnostic algorithm. (E) The analyzed entities were categorized into (1) entities in which TP53 aberrations were frequently detected and/or showed a prognostic influence (marked in gray; left), (2) cases for which the TP53 alteration frequency was very low or not detectable and/or did not show prognostic relevance (marked in red; right), and (3) entities for which the TP53 alteration frequency or prognostic influence is questionable (middle). AML without defining genetic abnormalities were summarized as AML-NOS (not otherwise specified). ∗, TP53 alterations in t-AML cases were rare in our analysis because of the low number of t-AML cases included in our cohort; however, t-AMLs are known to frequently harbor TP53 alterations, hence they were included into category 1. (F) Proposed categories for TP53 sh (left) and TP53 dh events (right). Marked with gray background are events that have impact on the prognosis in patients with AML and MDS.