Acute myeloid leukemia with t(3;21)(q26.2;q22) is always associated with poor outcome.[2] In this case, the patient did not respond satisfactorily to chemotherapy, indicating that traditional chemotherapy regimens may be ineffective for patients carrying RUNX1-MECOM and RUNX1-RPL22 fusion genes. Here, MECOM is linked to acute myeloid leukemia.