Allogeneic hematopoietic cell transplantation (allo-HCT) is increasingly relevant for elderly patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) due to expanding eligibility. How to improve the prognosis of this patient group remains challenges. This retrospective analysis enrolled 254 patients aged 50-65 who underwent allo-HCT after myeloablative conditioning (MAC) regimens in the past decade. Patients were stratified into high- and standard-risk groups based on their pretransplant disease status and measurable residual disease (MRD) level. In the standard-risk group (n=79), older age (≥55 years) and higher hematopoietic cell transplantation-specific comorbidity index (HCI-CI) scores (≥2) were associated with worse leukemia-free survival (LFS) (hazard ratio [HR], 1.76, p = 0.030; HR, 2.34; p = 0.006) and overall survival (OS) (HR, 1.78, p = 0.032; HR, 2.53, p = 0.003). However, age and HCT-CI scores were not associated with prognosis in high-risk patients. In the high-risk group (n=175), normal/underweight body mass index (BMI < 24 kg/m2) was associated with worse LFS (HR, 2.30; p = 0.007) and OS (HR, 2.94; p = 0.001). Therefore, older age and higher HCT-CI scores were associated with clinical outcomes in standard-risk elderly patients. Meanwhile, the pretransplantation BMI and transplantation type significantly influenced the outcomes of high-risk patients.

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2024
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