Demographic patterns and survival outcomes in acute myeloid leukemia with t(6;9)(p23;q34); DEK–NUP214.

Abstract

e18553 Background: Acute myeloid leukemia (AML) with t(6;9)(p23;q34); DEK–NUP214 is a rare, adverse-risk cytogenetic subtype characterized by aggressive clinical behavior and poor outcomes. Due to its low incidence, representing 0.6 - 1.7% of AML cases in children and 1% of AML cases in adults, population-level survival patterns and demographic predictors of prognosis remain poorly defined. We aimed to evaluate overall survival (OS), cancer-specific survival (CSS), and the impact of demographic and socioeconomic factors in this high-risk AML subtype. Methods: Adult patients with AML harboring t(6;9)(p23;q34) (DEK–NUP214) were identified from 17 SEER registries between 2000 and 2021. Cases with microscopic confirmation and non-missing survival data were included. Variables analyzed included age at diagnosis, sex, race, household income, and year of diagnosis. OS was defined as death from any cause and CSS as death attributable to AML. Kaplan–Meier methods were used to estimate survival. Multivariable Cox proportional hazards models were performed to evaluate associations with OS and CSS. Results: A total of 83 patients were included. Median survival was 17 months (IQR 9–36; mean 29.3 months). Females comprised 51% of the cohort. Most patients were White (75%), and the majority were in the middle-income category (56%), followed by high-income (38%) and low-income (6%). During follow-up, 47 patients (57%) died from any cause and 39 (47%) experienced AML-related death. Age ≥60 years was associated with worse overall survival (HR 2.56, 95% CI 1.33–4.91; P=0.0048) and cancer-specific survival (HR 2.15, 95% CI 1.06–4.37; P=0.035). Sex was not significant. Patients from racial/ethnic groups other than White showed a non-significant trend toward poorer OS (HR 1.36, 95% CI 0.66–2.81; P=0.401) and CSS (HR 1.55, 95% CI 0.71–3.38; P=0.269). Middle- and low-income patients did not differ significantly from high-income patients. Later year of diagnosis showed a modest, non-significant improvement in CSS. Conclusions: AML with t(6;9)(p23;q34); DEK–NUP214 is associated with early mortality. Advanced age remains the strongest predictor of adverse outcomes, while race and income showed non-significant trends. Findings should be interpreted cautiously due to the limited SEER sample and warrant validation in larger cohorts. Multivariable Cox regression for overall and cancer-specific survival in t(6;9) AML (DEK-NUP214). Characteristic HR (95% CI, OS) P value (OS) HR (95% CI, CSS) P value (CSS) Age ≥ 60 vs < 60 2.56 (1.33-4.91) 0.005 2.15 (1.06-4.37) 0.035 Male vs Female 0.73 (0.39-1.37) 0.328 0.72 (0.36-1.43) 0.353 Racial/ethnic group other than White vs White 1.36 (0.66-2.81) 0.401 1.55 (0.71-3.38) 0.269 Income: Middle vs High 1.43 (0.72-2.81) 0.306 1.37 (0.65-2.86) 0.408 Income: Low vs High 1.12 (0.3-4.14) 0.869 0.87 (0.18-4.14) 0.864 Year of diagnosis (per year) 0.93 (0.83-1.03) 0.168 0.91 (0.81-1.03) 0.127