What question did this study set out to answer?

This analysis aims to identify risk factors for secondary acute myeloid leukemia transformation and establish a prognostic model for patients with myeloproliferative neoplasms.

March 26, 2026Annals of Hematology0 citationsOpen Access

Risk factors for leukemic transformation in myeloproliferative neoplasms and prognostic factors in secondary acute myeloid leukemia: an exploratory analysis of the SEER database

SWS. Wang HZHaoyu Zang WDWenjing Du

Key Points

This analysis aims to identify risk factors for secondary acute myeloid leukemia transformation and establish a prognostic model for patients with myeloproliferative neoplasms.
Conducted a retrospective analysis using the SEER database.
Applied multivariable competing risk regression to assess risk factors.
Employed Cox proportional hazards regression to evaluate post-progression survival.
Performed subgroup analysis to identify variations in prognostic factors across age groups.
Found that being female and having polycythemia vera or essential thrombocythemia protected against transformation to sAML.
Identified American Indian/Alaska Native/Asian Pacific Islander race and lower household income as risk factors.
Established that age at diagnosis and chemotherapy history were significant predictors of post-progression survival.
Developed a prognostic risk model based on independent factors that stratifies patients effectively.

Abstract

To identify risk factors for secondary acute myeloid leukemia (sAML) transformation in myeloproliferative neoplasms (MPN), determine prognostic factors, and construct a reliable prognostic risk model, this study performed a retrospective analysis using the US Surveillance, Epidemiology, and End Results (SEER) database. Multivariable competing risk regression revealed that female (HR = 0. 84, P = 0. 012), polycythemia vera (PV, HR = 0. 29, P < 0. 0001) or essential thrombocythemia (ET, HR = 0. 26, P < 0. 0001) were protective factors against sAML transformation. In contrast, American Indian/Alaska Native/Asian Pacific Islander (AIAN/API) race (HR = 1. 31, P = 0. 034), household income <70, 000 (HR = 1. 21, P = 0. 022), chemotherapy history (HR = 1. 80, P < 0. 0001), and MPN diagnosis during 2011–2022 (HR = 1. 29, P = 0. 0001) were risk factors for leukemic transformation. Multivariate Cox proportional hazards regression showed that MPN-phase chemotherapy (HR = 1. 25, P = 0. 002), MPN diagnosis at age 60–75 years (HR = 1. 34, P = 0. 012), and sAML diagnosis at age ≥ 75 years (HR = 1. 83, P = 0. 001) were independent risk factors for post-progression survival (PPS) in patients with MPN-sAML. while sAML-phase chemotherapy was an independent protective factor (HR = 0. 39, P < 0. 001). Subgroup analysis revealed heterogeneity in prognostic factors among different sAML subgroups, but the protective effect of sAML-phase chemotherapy was consistently observed across all subgroups. Further multivariable Cox proportional hazards subgroup analysis suggested heterogeneity in the benefit of sAML-phase chemotherapy across age groups (P for interaction = 0. 041), with attenuated benefit observed in patients aged 60–75 years (HR = 0. 41) and ≥ 75 years (HR = 0. 42) compared to younger patients aged 20–60 years (HR = 0. 17). The prognostic risk model constructed based on independent prognostic factors and MPN subtypes can effectively stratify patients and provide a reference for risk stratification in patients with MPN-sAML.

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