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Myeloid neoplasms (MN) with MECOM rearrangements can present either myelodysplastic neoplasms (MDS) or acute myeloid leukaemia (AML), both associated with dismal prognosis. The 2022 WHO classification now defines these as ‘AML with MECOM rearrangements’ regardless of blast counts due to similarly poor outcomes.1 Classic MECOM rearrangements include inv(3)(q21q26.2) and t(3;3)(q21;q26), referred to as inv(3)/t(3;3), while non-classic subtypes involve 3q26.2/MECOM with other partners.2 Both forms result in MECOM overexpression promoting leukemogenesis. Chemotherapy outcomes are poor, with median overall survival rates of 12.9 months in MDS and 7.9 months in AML.3 This study aimed to determine the frequency, clinical characteristics and treatment outcomes of this subtype among Thai patients from the national MN registry.