Feasibility of allogeneic hematopoietic stem cell transplantation in advanced age

Although it is known that increasing age is associated with increased morbidity and mortality in allogeneic transplantation (allo-HSCT), individualization of the process may allow to perform it in progressively older patients. This study analyzed the outcome of 97 patients older than 60 years with a first allo-HSCT performed at our institution between 2011 and 2019. Median age was 66 years (range 60–79) and 15.4% were older than 70 years. The most frequent diagnosis was acute leukemia (50.5%), and 58.8% received a myeloablative conditioning. With a median follow-up of 33.9 months (range 7.9-111.5), at 3-years overall survival (OS) was 50%; progression-free survival (PFS), 46%; cumulative incidence of relapse, 22%; and non-relapse mortality (NRM), 32%. There were no significant differences in OS ( p = 0.415), PFS ( p = 0.691), cumulative incidence of relapse ( p = 0.357) or NRM ( p = 0.658) between patients of 60–64 years ( n = 37), 65–69 ( n = 45) and ≥ 70 years ( n = 15). No differences were observed either depending on the intensity of the conditioning regimen in terms of OS ( p = 0.858), PFS ( p = 0.729), cumulative incidence of relapse ( p = 0.416) or NRM ( p = 0.270). In conclusion, older adults can safely and effectively undergo allo-HSCT with proper patient selection and individualized transplantation procedures.