During patient follow-up, the 3-year cumulative incidence of leukemias (MDS, MPN, AML, CML, CLL) was significantly higher in patients with composite CH genotypes (14.6%, CI: 7–22%) as compared to patients with either mCA, gene mutation PD only, or neither, of which all had a 3-year cumulative incidence of less than 1% (Fig. 4c). Here, C4B is linked to myelodysplastic syndrome.