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We retrospectively explored the prognostic impact of DAT mutations at diagnosis in 122 RUNX1 mut  AML patients. RUNX1 missense mutation was dominant in the RUNT domain, and frameshift mutation was dominant in the TAD domain. DAT mutations occurred in 38.5% of RUNX1 mut  AML. After propensity score matching, DAT pos  patients had worse two-year relapse-free survival (RFS) than DAT neg  patients ( p  = .041). Moreover, RUNX1 high  (VAF ≥ 37.6%) patients showed poorer two-year overall survival (OS) and RFS than RUNX1 low  (VAF &lt; 37.6%) patients (OS,  p  = .033; RFS,  p  = .027), especially in the RUNX1 high DAT pos  group. Additionally, multivariate analysis confirmed that DAT mutations at diagnosis were an independent adverse factor for RFS. There were no significant differences in two-year OS and RFS between DAT pos  and DAT neg  patients or between RUNX1 high  and RUNX1 low  patients who undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Collectively, DAT mutations at diagnosis were adverse factors for RFS, and allo-HSCT could likely improve the poor outcomes of these patients.

RUNX1 together with DAT mutations predicted poor outcome in acute myeloid leukemia