Myeloproliferative neoplasm risk among U.S. veterans increases over time
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Key takeaways:
- Persian Gulf War-era veterans had higher risk for myeloproliferative neoplasms than veterans of the Korean or Vietnam war eras.
- Persian Gulf War-era veterans also had poorer survival after diagnosis.
Risk for myeloproliferative neoplasms among U.S. veterans increased significantly over time, according to retrospective study results.
Persian Gulf War-era veterans exhibited substantially higher risk than those who served in the Vietnam or Korean war eras.
“The results of this study strongly suggest inclusion of myeloproliferative neoplasms to the list of presumed consequences of service-connected exposures and their potential contributions to developing hematological myeloid neoplasms,” Andrew Tiu, MD, hematology/oncology fellow with MedStar Georgetown University Hospital, and colleagues wrote. “This is particularly pertinent for the younger veterans from [the] Persian Gulf War era who would benefit from early screening and timely therapy.”
Background and methods
The Promise to Address Comprehensive Toxics Act — signed into law in 2022 — expanded health care benefits to veterans who developed conditions related to toxic exposures.
Exposure to hazards such as Agent Orange during the Vietnam War and burn pits during the Persian Gulf War have been linked to numerous cancers, according to study background.
However, myeloproliferative neoplasms — such as polycythemia vera, essential thrombocythemia and primary myelofibrosis — have not been recognized as potential conditions resulting from service.
Tiu and colleagues used the Veterans Affairs Informatics and Computing Infrastructure (VINCI) database to evaluate incidence of myeloproliferative neoplasms among veterans who served in the Korean, Vietnam or Persian Gulf war eras.
The study cohort consisted of 506,623 individuals from Illinois — 65,425 veterans from the Korean War era (98.9% men; 70% white), 211,927 veterans from the Vietnam War era (96.6% men; 67.7% white), 214,007 veterans from the Persian Gulf War era (78% men; 64.9% white), and 15,264 nonveterans (58.3% women; 18.5% white; 7% Black; 72.2% unknown race).
Nonveterans included spouses or children of veterans, humanitarians, Peace Corps volunteers, and staff from the Office of Workers’ Compensation or other federal departments.
All veterans in the cohort had been seen in outpatient, inpatient or fee basis settings between Jan. 1, 2006, and Jan. 26, 2023.
Association of myeloproliferative neoplasms among veterans from different eras and incidence of arterial thrombosis, venous thrombosis and bleeding served as primary objectives. Differences in OS served as the secondary objective.
Results and next steps
Persian Gulf War-era veterans exhibited higher risk for myeloproliferative neoplasms than those from the Korean War (HR = 4.92; 95% CI, 4.2-5.75) or Vietnam War (HR = 2.49; 95% CI, 2.2-2.82) eras.
They also were younger at the time of diagnosis. Two-thirds (67.5%) of Persian Gulf War-era veterans received their myeloproliferative neoplasm diagnosis at age 50 years or younger, compared with 5.6% of Vietnam War-era veterans and 0% of Korean War-era veterans.
Those who served in the Persian Gulf War era had poorer survival after myeloproliferative neoplasm diagnosis than those who served in the Korean War era (HR = 5.55; 95% CI, 4.13-7.47) and Vietnam War era (HR = 2.39; 95% CI, 1.79-3.19).
“This necessitates evaluating the entire U.S. veteran cohort from Persian Gulf War era for closer follow-up of thrombo-hemorrhagic complications, transformation to leukemia, symptom burden, fertility complications and socioeconomic issues [among] young adults,” researchers wrote.
Vietnam War-era veterans exhibited increased risk for myeloproliferative neoplasms (HR = 1.97; 95% CI, 1.77-2.21) and poorer survival after diagnosis (HR = 2.33; 95% CI, 2.06-2.62) than Korean War-era veterans.
“These findings suggest that Agent Orange exposure among Vietnam War era veterans may have mediated these events,” Tiu and colleagues wrote.
Persian Gulf War-era veterans exhibited elevated risk for polycythemia vera, essential thrombocythemia, primary myelofibrosis, arterial thrombosis, venous thrombosis and bleeding than veterans from other eras.
Vietnam War-era veterans exhibited higher risk for arterial thrombosis, venous thrombosis and bleeding than Korean War-era veterans.
Black veterans demonstrated higher risk for essential thrombocythemia than with white veterans (HR = 1.62; 95% CI, 1.44-1.83). Risks for arterial thrombosis, venous thrombosis and bleeding also were higher among Black veterans than white veterans.
Veterans with a smoking history exhibited higher risk for myeloproliferative neoplasms than nonsmokers across all eras (HR = 4.28; 95% CI, 3.94-4.66).
Researchers identified no myeloproliferative neoplasm cases among nonveterans in the cohort. However, investigators noted this may be due to inadequate sampling, given prevalence of myeloproliferative neoplasms in the general population is approximately 0.5 to 1 case per 100,000 people.
Tiu and colleagues acknowledged study limitations, including its retrospective nature, potential for misclassification of diseases and possible bias of exposure measurement to hazards such as Agent Orange.
“Future studies should validate these findings by examining the entire veteran cohort, following recommended surveillance case definitions, confirming diagnosis through respective Veterans Affairs registries, and incorporating [Individual Longitudinal Exposure Record] data with VINCI database,” Tiu and colleagues wrote.
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