Allogeneic hematopoietic stem cell transplantation in elderly patients (age over 70 years) with high grade myelodysplasia or high risk acute myeloid leukemia.

Abstract

e18547 Background: Elderly patients (over the age of 65 years) treated with allogeneic hematopoietic stem cell transplants (AHSCT) tend to do poorly with a reported 5-year survival rate of 30%. Treatment related mortality at 100 days has been reported to be as high as 30% and relapse is common. With the advent of better regimens to mitigate acute and chronic graft versus host disease (GVHD), we conducted a retrospective study of the patients who underwent AHSCT at Advocate Lutheran General ALGH) from 2019 to 2024. Methods: We reviewed the records of 31 patients treated at ALGH who underwent AHSCT. There were 21 men and 10 women with a median age of 73 years (range 70-77 years) and the median PS was 0 (range 0-1). The conditioning regimens were busulfan/fludarabine/cyclophosphamide (blu/flu/cy) 10 patients; blu/flu/anti-thymocyte globulin 12 patients; blu/flu/post-cyclophosphamide 7 patients and blu/flu/thiotepa 2 patients. Results: Of the 31 patients transplanted 23 had acute myeloid leukemia; 7 patients had MDS, and 1 patient had aplastic anemia. Treatment related mortality at 100 days was 9/31, 29% and primarily related to sepsis. 5 patients relapsed with AML, and 5 died from complication of GVHD. The actuarial relapse free survival at 3 years is 39% with 12 patients alive from day 180 to day 2037. Conclusions: Allogeneic hematopoietic stem cell transplants in elderly patients are challenging and more studies need to be performed in these patients.