Clinical features, epidemiology, and survival of patients with core binding factor acute myeloid leukemia in the SEER database

Core binding factor acute myeloid leukemia (CBF-AML) (RUNX1::RUNX1T1 or CBFB::MYH11) is a favorable-risk but heterogenous subtype of acute myeloid leukemia (AML). However, understanding of its epidemiology, clinical characteristics, and prognosis is limited. A total of 70,912 records of adults with AML, including 947 with CBFB::MYH11 and 1,285 with RUNX1::RUNX1T1 CBF-AML were extracted from the Surveillance, Epidemiology, and End Results (SEER) database (2000–2023) and analyzed. Incidence trends were assessed using the annual percent change (APC); prognostic factors were identified using multivariable Cox regression; and survival was compared between groups using the Kaplan–Meier method. The CBFB::MYH11 and RUNX1::RUNX1T1 subtypes accounted for 1.3% and 1.8% of cases of AML, respectively, and incidence was higher in men and adults aged < 60 years. The incidence of CBF-AML increased significantly during the study period (APC 2.84% for CBFB::MYH11 and 2.89% for RUNX1::RUNX1T1 subtypes). Sex, age, and chemotherapy were independent predictors of overall survival (OS) in both subtypes. Second malignant neoplasm (SMN) was associated with poorer cancer-specific survival (CSS), and radiotherapy was associated with poorer OS in patients with RUNX1::RUNX1T1 AML. Patients with CBFB::MYH11 AML had longer OS and CSS than those with RUNX1::RUNX1T1 AML, but CSS did not differ significantly by subtype in patients aged ≥ 60 years. Untreated patients had a median OS of 1 month. The prognosis of CBF-AML is generally favorable but differs by subtype. Age, chemotherapy, and SMN are key predictors of survival. Timely diagnosis and initiation of chemotherapy is critical, especially in older patients.