《解决综合毒物承诺 (PACT) 法案》扩大了美国退伍军人的医疗保健和与服务相关暴露（例如烧坑、橙剂）相关疾病的福利。然而，骨髓增生性肿瘤（MPN）不被认为是接触这些有毒物质的退伍军人的推定病症。本研究评估了朝鲜战争、越南战争和波斯湾战争时期美国退伍军人 MPN 的发展情况。这项回顾性队列研究包括 65 425 名朝鲜战争时期的退伍军人； 211 927 越南战争时期退伍军人； 2006 年 1 月 1 日至 2023 年 1 月 26 日期间的 214 007 波斯湾战争时期退伍军人。通过 ICD-9 和 -10 代码识别出患有 MPN、血栓、出血和心血管危险因素的退伍军人。与朝鲜战争和越南战争时期的退伍军人相比，海湾战争时期的退伍军人患 MPN 的风险最高，风险比 (HR) 4.92，95% 置信区间 (CI) 4.20-5.75，HR 2.49，95% CI 2.20 -2.82，分别为 p < .0001。与朝鲜战争时期的退伍军人相比，越南战争时期的退伍军人患 MPN 的风险也更高，HR 1.97，95% CI 1.77-2.21，p< .0001。与朝鲜战争和越南战争时期的退伍军人相比，海湾战争时期的退伍军人被诊断出 MPN 的年龄较早，血栓和出血的风险较高，生存率较低。这项研究进一步证明环境和职业危害会增加克隆性骨髓疾病和相关并发症的风险，从而影响 MPN 的总体生存率。限制包括无法确认克隆性并完全验证部署和暴露状态。© 2024 作者。 《美国血液学杂志》由 Wiley periodicals LLC 出版。

The Promise to Address Comprehensive Toxics (PACT) Act expanded U.S. Veterans' health care and benefits for conditions linked to service-connected exposures (e.g., Burn Pits, Agent Orange). However, myeloproliferative neoplasms (MPN) are not recognized as presumptive conditions for Veterans exposed to these toxic substances. This study evaluated the development of MPN among U.S. Veterans from the Korean, Vietnam, and Persian Gulf War eras. This retrospective cohort study included 65 425 Korean War era Veterans; 211 927 Vietnam War era Veterans; and 214 007 Persian Gulf War era Veterans from January 1, 2006, to January 26, 2023. Veterans with MPN, thrombosis, bleeding, and cardiovascular risk factors were identified through ICD-9 and -10 codes. Veterans from the Persian Gulf War era had the highest risk of developing MPN compared with Veterans from the Korean and Vietnam War eras, hazard ratio (HR) 4.92, 95% confidence interval (CI) 4.20-5.75 and HR 2.49, 95% CI 2.20-2.82, both p < .0001, respectively. Vietnam War era Veterans also had a higher risk of MPN development compared with Korean War era Veterans, HR 1.97, 95% CI 1.77-2.21, p < .0001. Persian Gulf War era Veterans were diagnosed with MPN at an earlier age, had higher risks of thrombosis and bleeding, and had lower survival rates compared with Korean War and Vietnam War era Veterans. This study reinforces evidence that environmental and occupational hazards increase the risk of clonal myeloid disorders and related complications, impacting overall survival with MPN. Limitations include the inability to confirm clonality and fully verify deployment and exposure status.© 2024 The Author(s). American Journal of Hematology published by Wiley Periodicals LLC.