Temporal improvements in survival with persistent disparities in acute myeloid leukemia: a two-decade population-based analysis from the United States

Therapeutic advances have expanded treatment options for acute myeloid leukemia (AML), but it remains uncertain whether these improvements have led to equitable survival gains across populations. To investigate this, we conducted a retrospective cohort study using the SEER database, including 69,551 patients aged 15 years and older diagnosed with AML between 2000 and 2021. Survival outcomes, including overall survival (OS) and disease-specific survival (DSS), were evaluated across diagnostic periods from 2000 to 2019. To address differences in follow-up time, restricted mean survival time at 60 months (RMST60) was calculated, and multivariable Cox regression was used to assess associations between demographic, socioeconomic, and treatment-related factors and survival outcomes. Survival improved significantly over time, with OS RMST60 increasing from 15.7 months in 2000-2004 to 19.5 months in 2015-2019, and median OS rising from 5 to 8 months; DSS showed similar improvements. Age 65 years and older was the strongest adverse prognostic factor, while receipt of chemotherapy was associated with substantially better survival. Higher income and being married were also linked to improved OS, whereas Black race remained associated with worse OS even after adjustment. Urban-rural classification was not a significant factor in adjusted models. Despite overall progress in AML survival over two decades, substantial disparities persist, indicating that access to treatment and social determinants of health continue to play a critical role, and that therapeutic advances alone are insufficient to ensure equitable outcomes.