Cumulative incidence of high-risk clonal evolution. Time to high-risk clonal evolution was defined as the time elapsed from diagnosis to the date of development of TP53 abnormalities, BIRC3 abnormalities, NOTCH1 mutations, SF3B1 mutations, or del1q22-q23 (events) or last follow-up or death (censoring). Analysis was performed using death as a competing risk. Only patients who did not present high-risk abnormalities at diagnosis were included in this analysis. (A-D) Cumulative incidence of clonal evolution according to age > 65 years (hazard ratio [HR] = 4.18; 95% CI, 1.26-13.8; 5-year risk: 17.1%, 10-year risk: 32.9%;), high LDH (HR = 3.15; 95% CI, 1.32-7.55; 5-year risk: 24.8%, 9-year risk: 62.8%), unmutated IGHV genes (HR = 2.89; 95% CI, 1.31-6.39; 5-year risk: 18.5%, 9-year risk: 50.8%), +12 or a normal genetics (HR = 2.29; 95% CI, 1.03-5.10; 5-year risk: 13.8%, 9-year risk: 34.5%).