Predictors of Early Mortality in Acute Myeloid Leukemia: A Population Based Analysis Using SEER Data

Acute myeloid leukemia (AML) is associated with high early mortality, especially among older adults and those with limited access to care. This study utilizes a national cancer registry to identify demographic and disease-related predictors of early death in AML patients.

A retrospective cohort analysis was conducted using data from the Surveillance, Epidemiology, and End Results 8 database (November 2024 submission) covering cases diagnosed between 1975 and 2022. Patients with a diagnosis of non-M3 AML, defined by ICD-O-3 histology codes were included. Two primary endpoints were evaluated: early mortality within one month of diagnosis (EM1) and within 2 months of diagnosis (EM2). Binary logistic regression was performed to identify predictors of early mortality, and odds ratios (ORs) with 95% confidence intervals (CIs) were reported.

A total of 37,835 patients with non-M3 AML were included (median age 70 years), with early mortality rates of 33.4% at 1 month (EM1) and 39.7% at 2 months (EM2). Early mortality increased markedly with age, reaching 52.8% (EM1) and 62.3% (EM2) in patients > 75 years (P < .001). Receipt of chemotherapy significantly reduced early mortality, with lower EM1 (20.6% vs. 61.2%) and reduced adjusted odds for both EM1 (OR 0.19; 95% CI, 0.18-0.20) and EM2 (OR 0.12; 95% CI, 0.12-0.13) (P < .001). Across diagnostic eras, outcomes improved progressively from the chemotherapy era (1975-2005) to the HMA era (2006-2017) and venetoclax era (2018-2022), with EM1 declining from 37.1% to 30.7% to 29.1% and EM2 from 43.9% to 36.8% to 34.9% (P < .001). Sociodemographic factors were significant in univariate analyses but not after adjustment.

Early mortality in non-M3 AML remains high and is strongly influenced by age, chemotherapy receipt, and AML subtype. Improving timely treatment access and supportive care for high-risk patients may substantially reduce early deaths.