US Study Identifies Survival Trends and Disparities Across Myeloproliferative Neoplasms

Key Clinical Summary:  

• A US population-based analysis of 63 242 patients with myeloproliferative neoplasms (MPNs) found that essential thrombocythemia (ET) and polycythemia vera (PV) had higher incidence rates and more favorable survival outcomes than primary myelofibrosis (PMF).
• Five-year relative survival among patients with PMF improved from 50.9% in 2009 to 60.6% in 2016, although survival remained substantially lower than for other MPN subtypes.
• Advancing age was associated with poorer survival across MPN subtypes, while significant differences in incidence and overall survival were observed between men and women.

A large US population-based study identified important differences in incidence, prevalence, and survival among patients with MPNs, highlighting improvements in PMF outcomes alongside persistent disparities associated with age and sex.

The research, published in Leukemia, analyzed data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registries to evaluate long-term epidemiologic trends and survival outcomes among patients diagnosed with ET, PV, PMF, and chronic myeloid leukemia (CML). The findings provide updated population-level evidence that may help inform risk stratification, long-term disease management, and resource planning for US health care systems.

US Population Analysis Examines MPN Subtypes

Researchers analyzed SEER-17 registry data from 63 242 adults diagnosed with MPNs between 2000 and 2021.

The study population included 24 172 patients with ET, 23,456 with PV, 6131 with PMF, and 9483 with CML.

Investigators evaluated incidence rates, prevalence, relative survival, and overall survival across MPN subtypes, with additional analyses examining differences by age and sex.

Most MPN diagnoses occur after age 50 years, and incidence increased with advancing age. Approximately 62.5% of patients lived in metropolitan areas with populations exceeding 1 million, while 6.7% resided in households with annual incomes below $50 000.

Incidence and Prevalence Vary Across MPN Subtypes

Across the study period, ET and PV had the highest overall incidence rates, at 1.84 and 1.78 cases per 100 000 person-years, respectively. PMF and CML were less common, with incidence rates of 0.47 and 0.72 cases per 100 000 person-years, respectively.

Among adults aged 60 years or older, incidence rates were highest for ET and PV, reaching 4.67 and 4.56 cases per 100 000 person-years, respectively.

Sex-related differences were also observed. ET was more common among women, whereas PV predominated among men. Among adults aged 60 years or older, the incidence rate of ET was 5.20 per 100 000 person-years in women, while the incidence rate of PV was 5.40 per 100 000 person-years in men.

ET incidence increased over the study period, reaching 2.21 cases per 100 000 person-years in 2021. In contrast, PV and PMF incidence remained relatively stable.

Using SEER-8 registry data and US population estimates from July 2024, researchers estimated the number of adults living with each MPN subtype:

• ET: 64 641 patients
• PV: 54 604 patients
• PMF: 8678 patients
• CML: 29 716 patients

These estimates highlight the substantial number of US patients requiring ongoing monitoring and long-term management despite the relatively low incidence of individual MPN subtypes.

Survival Improves in Primary Myelofibrosis

Five-year relative survival varied substantially across MPN subtypes.

Patients with ET and PV demonstrated the most favorable outcomes, with 5-year relative survival rates of 93.3% and 91.6%, respectively. The corresponding rates were 86.2% for CML and 52.4% for PMF.

Despite having the lowest survival outcomes among the evaluated MPN subtypes, PMF demonstrated meaningful improvement over time.

Five-year relative survival among patients with PMF increased from 50.9% in 2009 to 57.4% in 2013 and 60.6% in 2016.

In patients with CML, 5-year relative survival increased from 72.6% in 2001 to 85.4% in 2005 and subsequently remained relatively stable at approximately 88%.

The findings suggest continued progress in outcomes for selected MPN populations, although the observational design does not establish whether improvements were attributable to specific treatments, diagnostic advances, or changes in disease management.

Age and Sex Associated With Survival Differences

Advancing age at diagnosis was associated with poorer survival across all MPN subtypes.

Among patients aged 80 years or older, 5-year relative survival was 83.8% for ET, 79.3% for PV, 58.4% for CML, and 30.8% for PMF.
Significant differences in overall survival were also observed between men and women.

Women with ET had a median overall survival of 168 months compared with 131 months among men (P < .001). Similar patterns were observed for PMF, with median survival of 63 months among women compared with 42 months among men (P < .001).

Women with CML also demonstrated longer median overall survival than men, at 212 months compared with 197 months (P = .0073).

However, the opposite pattern was observed in PV. Men had a median overall survival of 162 months compared with 136 months among women (P < .001).

These findings demonstrate substantial demographic variation in MPN outcomes and underscore the importance of considering age and sex when evaluating population-level disease burden.

Implications for Managed Care

The findings provide important insights for managed care organizations responsible for supporting patients with chronic hematologic malignancies.

Although MPNs are relatively uncommon, many patients require long-term treatment, monitoring, and management of disease-related complications. The estimated US prevalence of ET, PV, PMF, and CML illustrates the ongoing care needs associated with these conditions.

Differences in survival across MPN subtypes may also influence population health management strategies. Patients with PMF experienced substantially poorer outcomes than those with ET or PV, potentially supporting the need for closer monitoring, individualized treatment planning, and timely access to specialized hematology care.

The strong association between advancing age and poorer survival may be particularly relevant for Medicare populations, given that MPN incidence increases substantially among older adults.

Additionally, differences in survival between men and women highlight the importance of further investigating demographic factors that may influence treatment outcomes and access to care.

However, the study did not directly evaluate treatment utilization, insurance coverage, health care expenditures, or the causes of observed survival disparities. Additional research incorporating claims data and treatment information would be necessary to determine how these epidemiologic patterns translate into managed care costs and opportunities for intervention.

Conclusion

This US population-based analysis identified substantial differences in incidence, prevalence, and survival across MPN subtypes, with improving outcomes among patients with PMF but persistent disparities associated with age and sex.

The findings provide updated evidence on the burden of MPNs in the United States and may help inform long-term disease management, risk stratification, and resource planning as treatment options continue to evolve.

Reference

Singhal S, Mishra R, Arora S, et al. Incidence, prevalence, and survival outcomes of patients with myeloproliferative neoplasms in the United States: a Surveillance, Epidemiology, and End Results (SEER) database analysis, years 2000–2021. Leukemia. 2026. doi.org:10.1038/s41375-026-03124-9