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

Q: Which factors were protective against sAML transformation in MPN patients?

The analysis found female sex and MPN subtypes polycythemia vera (PV) and essential thrombocythemia (ET) were protective factors against sAML transformation.

Q: What variables increased the risk of leukemic transformation?

Increased risk was associated with AIAN/API race, household income below $70,000, chemotherapy history, and MPN diagnosis during 2011–2022.

Q: How did chemotherapy during MPN phase and sAML phase relate to post-progression survival?

MPN-phase chemotherapy and MPN diagnosis at older ages were independent risk factors for post-progression survival, whereas sAML-phase chemotherapy was an independent protective factor.

Sep 23, 2026

Uploaded by Sarah

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. Competing-risk regression showed sex and MPN subtype variables as protective (female, polycythemia vera, essential thrombocythemia), while race, lower household income, chemotherapy history, and later MPN diagnosis periods increased transformation risk. Cox models further linked MPN-phase chemotherapy and older diagnostic ages to post-progression survival risk, while sAML-phase chemotherapy reduced risk and benefits persisted across sAML subgroups.

LanguageEnglish

CategoryHealthcare

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Pages14

Reading Time35 min

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Abstract

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Introduction

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Annals of Hematology (2026) 105:204 [https://doi.org/10.1007/s00277-026-06942-0](https://doi.org/10.1007/s00277-026-06942-0) RESEARCH Risk factors for leukemic transformation in myeloproliferative neoplasms and prognostic factors in secondary acute myeloid leukemia: an exploratory analysis of the SEER database Shuainan Wang1 · Haoyu Zang2 · Wenjing Du1 · Laibing Guo2 · Jingyan Song2 · Tianyu Qiao1 · Weiying Gu1,2 Received: 14 October 2025 / Accepted: 6 March 2026 / Published online: 25 March 2026 © The Author(s) 2026 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 MPNsAML. 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. Keywords MPN · MPN-sAML · Leukemic transformation risk · SEER · prognostic risk model Introduction MPNs are a group of clonal hematopoietic disorders characterized by the abnormal proliferation of mature myeloid cells. Philadelphia chromosome-negative MPNs (Ph-negative MPNs) primarily include PV, ET and Primary Myelofibrosis (PMF) [1] . MPN patients often present with a 􀀍 Weiying Gu[guweiying2001@163.com](guweiying2001@163.com) 1 Changzhou Medical Center, Nanjing Medical University, Changzhou 213003, China 2 The First People’s Hospital ofChangzhou, Soochow University, Changzhou 213003, China range of systemic symptoms, such as fatigue, night sweats, weight loss, and fever, and the majority have splenomegaly [2] . More critically, the risk of leukemic transformation is significantly higher in MPN patients compared to the general population [3] . The 10-year risk of leukemic transformation varies among subtypes: approximately 1% for ET, about 2.3% for PV, and as high as 10%-20% for PMF [4–6] . The prognosis of sAML is exceedingly poor. In a PETHEMA registry study comprising 2,310 sAML patients, the median overall survival (OS) of de novo AML (dnAML) was nearly twice that of sAML (10.9 months vs. 5.6 months, P < 0.001). Among sAML subtypes, patients whose sAML evolved from myelodysplastic syndromes (MDS), MDS/ MPN overlap syndromes, or MPNs had the worst prognosis, with a median OS of only 5.3 months [7] .

FAQs

Which factors were protective against sAML transformation in MPN patients?

The analysis found female sex and MPN subtypes polycythemia vera (PV) and essential thrombocythemia (ET) were protective factors against sAML transformation.

What variables increased the risk of leukemic transformation?

Increased risk was associated with AIAN/API race, household income below $70,000, chemotherapy history, and MPN diagnosis during 2011–2022.

How did chemotherapy during MPN phase and sAML phase relate to post-progression survival?

MPN-phase chemotherapy and MPN diagnosis at older ages were independent risk factors for post-progression survival, whereas sAML-phase chemotherapy was an independent protective factor.

Sep 23, 2026

Uploaded by Sarah