SEER Nomograms for Acute Erythroid Leukemia Survival
NEW nomograms improved survival prediction for acute erythroid leukemia, highlighting age and chemotherapy as factors nationwide.
Acute erythroid leukemia is a rare and highly aggressive subtype of acute myeloid leukemia with poor prognosis and no standardized treatment strategy. Its rarity and molecular complexity can make conventional staging less reliable for forecasting outcomes.
In a retrospective analysis, researchers drew on the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2021 to identify 778 patients with acute erythroid leukemia. Patients were randomly assigned to a training cohort (544 patients) and a validation cohort (234 patients). Cox regression was then used to determine independent prognostic factors for overall survival and cancer specific survival, which were incorporated into two nomogram models.
Key Prognostic Factors Identified
Multivariable analyses found four factors independently associated with both overall survival and cancer specific survival: age, receipt of chemotherapy, marital status, and whether the leukemia was a first primary tumor. The nomograms demonstrated moderate discrimination, with concordance indices of 0.669 for overall survival and 0.665 for cancer specific survival in the training cohort. Performance remained similar in the validation cohort, with values of 0.654 and 0.661, respectively.
Receiver operating characteristic analyses supported predictive accuracy, while calibration curves showed good agreement between predicted and observed survival. Decision curve analysis suggested the models could provide clinical value across a range of threshold probabilities. Using the nomogram derived score, the team also created a risk stratification approach that separated patients into high and low risk groups, with significantly different outcomes.
Limitations and Next Steps
These nomograms offer a practical approach to prognosis in acute erythroid leukemia using variables commonly recorded in routine datasets. However, the authors noted an important limitation: SEER lacks molecular details, including TP53 mutations, which can meaningfully affect disease biology and survival. External validation in independent patient cohorts will be necessary before the models can be considered for broader clinical implementation.
Reference: Ma X et al. Prognostic nomograms for predicting overall and cancer-specific survival in acute erythroid leukemia: a SEER-based study. Discov Oncol. 2026;doi:10.1007/s12672-026-04465-8.
