Table 2.

Transition-specific covariate effect estimates in the multistate model according to CMML risk at diagnosis

CovariatesTransitionLower-risk CMMLHigher-risk CMML
HR (95% CI)PHR (95% CI)P
AML vs diagnosis state To death 4.99 (3.23-7.72) <.001 3.60 (2.51-5.16) <.001 
Allo-HCT from AML vs from diagnosis To death 1.49 (0.86-2.59) .159 1.19 (0.68-2.07) .547 
AML vs diagnosis state To allo- HCT 8.34 (3.97-17.50) <.001 5.48 (2.60-11.52) <.001 
Female vs male Diagnosis to AML 0.78 (0.46-1.33) .367 0.72 (0.47-1.11) .135 
Age at diagnosis* Diagnosis to AML 1.07 (0.77-1.49) .683 0.79 (0.66-0.94) .008 
Female vs male Diagnosis to allo-HCT 1.11 (0.55-2.24) .766 1.40 (0.68-2.89) .359 
Age at diagnosis* Diagnosis to allo-HCT 0.47 (0.35-0.64) <.001 0.60 (0.45-0.78) <.001 
Female vs male Diagnosis to death 0.69 (0.45-1.05) .082 0.73 (0.51-1.06) .099 
Age at diagnosis* Diagnosis to death 1.14 (0.87-1.48) .347 1.29 (1.01-1.64) .045 
Female vs male AML to allo-HCT 0.44 (0.10-1.97) .280 0.90 (0.32-2.53) .844 
Age at diagnosis* AML to allo-HCT 0.64 (0.40-1.02) .058 0.72 (0.51-1.01) .056 
Female vs male AML to death 0.74 (0.37-1.46) .383 0.87 (0.52-1.44) .583 
Age at diagnosis* AML to death 1.15 (0.77-1.70) .494 1.16 (0.88-1.52) .289 
Female vs male Allo-HCT (prior to AML) to death 0.55 (0.33-0.93) .025 1.24 (0.85-1.87) .317 
Age at diagnosis* Allo-HCT (prior to AML) to death 1.17 (0.87-1.58) .304 1.05 (0.87-1.26) .625 
Female vs male Allo-HCT (post-AML) to death 0.54 (0.17-1.64) .274 0.83 (0.31-2.22) .708 
Age at diagnosis* Allo-HCT (post-AML) to death 1.83 (0.74-4.52) .192 1.09 (0.67-1.79) .729 
CovariatesTransitionLower-risk CMMLHigher-risk CMML
HR (95% CI)PHR (95% CI)P
AML vs diagnosis state To death 4.99 (3.23-7.72) <.001 3.60 (2.51-5.16) <.001 
Allo-HCT from AML vs from diagnosis To death 1.49 (0.86-2.59) .159 1.19 (0.68-2.07) .547 
AML vs diagnosis state To allo- HCT 8.34 (3.97-17.50) <.001 5.48 (2.60-11.52) <.001 
Female vs male Diagnosis to AML 0.78 (0.46-1.33) .367 0.72 (0.47-1.11) .135 
Age at diagnosis* Diagnosis to AML 1.07 (0.77-1.49) .683 0.79 (0.66-0.94) .008 
Female vs male Diagnosis to allo-HCT 1.11 (0.55-2.24) .766 1.40 (0.68-2.89) .359 
Age at diagnosis* Diagnosis to allo-HCT 0.47 (0.35-0.64) <.001 0.60 (0.45-0.78) <.001 
Female vs male Diagnosis to death 0.69 (0.45-1.05) .082 0.73 (0.51-1.06) .099 
Age at diagnosis* Diagnosis to death 1.14 (0.87-1.48) .347 1.29 (1.01-1.64) .045 
Female vs male AML to allo-HCT 0.44 (0.10-1.97) .280 0.90 (0.32-2.53) .844 
Age at diagnosis* AML to allo-HCT 0.64 (0.40-1.02) .058 0.72 (0.51-1.01) .056 
Female vs male AML to death 0.74 (0.37-1.46) .383 0.87 (0.52-1.44) .583 
Age at diagnosis* AML to death 1.15 (0.77-1.70) .494 1.16 (0.88-1.52) .289 
Female vs male Allo-HCT (prior to AML) to death 0.55 (0.33-0.93) .025 1.24 (0.85-1.87) .317 
Age at diagnosis* Allo-HCT (prior to AML) to death 1.17 (0.87-1.58) .304 1.05 (0.87-1.26) .625 
Female vs male Allo-HCT (post-AML) to death 0.54 (0.17-1.64) .274 0.83 (0.31-2.22) .708 
Age at diagnosis* Allo-HCT (post-AML) to death 1.83 (0.74-4.52) .192 1.09 (0.67-1.79) .729 

Because some pairs of transitions were assumed to be proportional, they share the same baseline hazard function. The relative difference of the hazards, within a pair, is expressed in terms of hazard ratio. For example, the hazard of death (without/before transplantation) after transformation to AML for lower-risk patients is estimated to be 5 times as high as the hazard of death without transformation to AML. Similarly, an effect of transformation to AML was estimated on the hazard of transplantation and the hazard of death after transplantation. Additionally, transition-specific age and sex effects were modeled. The same multistate model was estimated separately in lower- and higher-risk CMML patients as CPSS risk violated the proportional hazards assumption.

*

Age by unit of 10 years.

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