Intriguingly, the impact of DNMT3A mutation on OS and time to leukemia transformation remained significant after adjusting the effects of age, gender, IPSS-R [37, 38], and mutations with prognostic significance in multivariate Cox regression analysis (FAB defined patients: OS: hazard ratio, HR 1.733, 95% CI 1.118–2.688, P = 0.014; time to leukemia transformation: HR 3.088, 95% CI 1.574–6.056, P = 0.001; 2016 WHO classification defined patients: OS: HR 1.800, 95% CI 1.080–3.000, P = 0.024; time to leukemia transformation: HR 2.360, 95% CI 1.129–4.933, P = 0.022; Table 3). The gene discussed is DNMT3A; the disease is leukemia.