{
  "abstract": "Higher-risk myelodysplastic syndromes (MDS) are frequently complicated by severe infections, yet the impact of molecular subgroups on infection susceptibility remains poorly defined. Biallelic TP53 (bi-TP53) alterations identify a high-risk molecular subset linked to adverse outcomes, but their contribution to infection incidence and infection-related mortality has not been systematically studied. We retrospectively analyzed 97 hospitalized higher-risk MDS patients (IPSS-R ≥4) identified through hospitalizations between June 2023 and April 2026. Patients were grouped by TP53 allelic status, and infection-related outcomes were compared. Clinically significant infections were defined as suspected or documented events requiring inpatient management and/or intravenous anti-infective therapy. Outcomes included infection incidence, recurrent infection, anti-infective escalation, baseline lymphocyte subsets, overall survival, and composite event-free survival (cEFS; infection-related death or AML transformation). Cox regression evaluated cEFS, and Firth penalized logistic regression assessed infection-related death. IPSS-M risk category was also analyzed. Among 97 patients, 31 had bi-TP53 alterations. During a median follow-up of 0.8 years, 59 patients (60.8%) developed clinically significant infections and 27 (27.8%) died from infection. Compared with non-bi-TP53 patients, bi-TP53 patients had higher rates of infection (87.1% vs. 48.5%), recurrent infection (54.8% vs. 30.3%), infection within 100 days after diagnosis (77.4% vs. 28.8%), and infection within 1 year after diagnosis (83.9% vs. 39.4%; all P<0.05). Among infected patients, bi-TP53 alterations were associated with more severe infection, greater anti-infective treatment escalation (85.2% vs. 31.3%), more frequent antifungal therapy use (74.1% vs. 15.6%), and higher infection-related mortality (85.2% vs. 12.5%; all P<0.001). Baseline neutrophil, hemoglobin, and platelet counts were comparable between groups, whereas CD3+ T-cell, CD4+ T-cell, CD8+ T-cell, and NK-cell counts were significantly lower in bi-TP53 patients. In multivariable analysis, bi-TP53 alterations remained associated with shorter cEFS (HR = 7.56, 95% CI: 2.79-20.46) and infection-related death among infected patients (OR = 7.52, 95% CI: 1.15-49.37). Bi-TP53 alterations were associated with greater infectious burden, lower circulating T-cell and NK-cell counts, and higher infection-related mortality in hospitalized patients with higher-risk MDS. These observational findings do not establish causality or independence from neutropenia. Prospective multicenter studies should assess their value for infection risk stratification and supportive-care planning.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Hematology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Binbin Lai"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiao Yan"
    },
    {
      "affs": [
        0
      ],
      "name": "Lieguang Chen"
    },
    {
      "affs": [
        0
      ],
      "name": "Yi Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Lixia Sheng"
    },
    {
      "affs": [
        0
      ],
      "name": "Guifang Ouyang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9rbjd34946eg9.bib",
  "cited_by": 0,
  "doi": "10.3389/fcimb.2026.1908881",
  "fulltext_url": "https://europepmc.org/articles/PMC13713890",
  "id": "9rbjd34946eg9",
  "issns": [
    "2235-2988"
  ],
  "landing_url": "https://europepmc.org/article/MED/42953204",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2720|Acute Myeloid Leukemia Research"
    ]
  ],
  "openalex": "W7221827070",
  "pdf_url": "https://europepmc.org/articles/PMC13713890?pdf=render",
  "pmcid": "PMC13713890",
  "pmid": "42953204",
  "published": "2026-10-14",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/9rbjd34946eg9.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:41Z",
      "native_id": "MED:42953204",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42953204"
    },
    {
      "first_seen": "2026-11-01T12:21:29Z",
      "native_id": "PMC13713890",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fcimb.2026.1908881"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2720|Acute Myeloid Leukemia Research",
      "subfield": "general"
    }
  ],
  "title": "Infectious burden and cellular immune impairment in higher-risk myelodysplastic syndromes with biallelic TP53 alterations.",
  "title_text": "Infectious burden and cellular immune impairment in higher-risk myelodysplastic syndromes with biallelic TP53 alterations.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:21:29Z",
  "url": "https://research.draconitic.com/paper/9rbjd34946eg9",
  "venue": "Frontiers in cellular and infection microbiology",
  "versions": []
}