Early mortality in acute myeloid leukemia

• EMR for AML is 26.7% in the SEER cohort in comparison to 12.2% in the SWOG cohort.
• Increasing age, black race, and monocytic differentiation predict higher EMR.
• No significant change in EMR was noted when analyzed by year of diagnosis.
• Our data suggests that AML should be treated in highly specialized centers to achieve lower EMR.

The Southwest Oncology Group (SWOG) described the expected early mortality rate (EMR) for patients with non-M3 AML by age enrolled in clinical trials, but it is unclear how generalizable this data is. We sought to compare SWOG's reported EMR to that of the general population by utilizing the case listing session of SEER 18 matched to the accrual periods of the SWOG studies. 26,272 patients were identified within SEER compared to 968 in the SWOG cohort with mortality data. The EMR was 26.7% (7022 events) in the SEER cohort versus 12.2% (116) in the SWOG cohort. The EMR was higher in the SEER cohort in every studied age group and definition of EMR. Stepwise logistic regression analysis identified increasing age, black race (OR 1.15, CI 1.03-1.29, p < 0.01), and monocytic differentiation (OR 1.55, CI 1.27-1.89, p < 0.01) as predictors of higher EMR. This study demonstrates that EMR in patients with non-M3 AML is higher in the general patient population than reported in SWOG clinical trials.