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Pre-transplant disease burden rather than age or donor type was associated with survival of hematopoietic cell transplantation for elderly patients with acute myeloid leukemia

Bone Marrow Transplantation volume 60, pages 107–109 (2025)Cite this article

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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the best treatment for patients with intermediate- to high-risk acute myeloid leukemia (AML) for prolonged disease control or cure [1]. In the early days, elderly patients (≥50 years old) were usually considered not eligible for allo-HSCT due to increased morbidity and mortality. With the development of tailormade conditioning regimens such as reduced intensity conditioning (RIC), coupled with improvement in supportive care and more accurate HLA typing, allo-HSCT have been broadened to the application in elderly patients [2]. However, numerous barriers remain. Although there have been studies focusing on allo-HSCT in elderly patients [3, 4], the factors influencing transplant outcomes remain controversial, compromising clinical decision-making. Furthermore, studies on elderly patients receiving haploidentical hematopoietic stem cell transplantation (haplo-HSCT) remain scarce. In the current study, we aimed to identify the factors related to transplant outcomes, in order to provide clues for future optimization of candidate selection and transplant protocols in elderly patients with AML.

A total of 199 elderly patients (≥50 years old) with AML who underwent allo-HSCT at Peking University People’s Hospital between June 2015 and November 2021 were enrolled in this retrospective study. The AML risk category was assessed according to the European Leukemia Net recommendations [2]. The burden of comorbidities before HSCT was evaluated using the hematopoietic cell transplantation-specific comorbidity index (HCT-CI) [1]. The standard conditioning regimen consisted of cytarabine (Ara-C, 4 g/m2/day, –9 day), busulfan (Bu, 3.2 mg/kg/day, –8 to –6 days), cyclophosphamide (Cy, 1.8 g/m2/day, –5 to –4 days), semustine (250 mg/m2, –3 day), and rabbit anti-thymocyte globulin (ATG, 2.5 mg/kg, –5 to –2 days; Sanofi, France). The RIC consisted of Ara-C (2 g/m2/day, –10 to –9 days), Bu (3.2 mg/kg/day, –8 to –6 days), fludarabine (Flu, 30 mg/m2/day, –6 to –2 days), Cy (1.0 g/m2/day, –5 to –4 days), semustine (250 mg/m2, -3 day), and ATG (2.5 mg/kg, -5 to -2 days). Neutrophil and platelet engraftment was defined as previously described [5]. Both acute and chronic graft-versus-host disease (GVHD) were graded according to international criteria [6]. Relapse, non-relapse mortality (NRM), leukemia-free survival (LFS) and overall survival (OS) were defined according to the literature [7].

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Fig. 1: Transplant outcomes according to disease status.

Data availability

The raw data supporting the conclusions of this article will be made available by the authors without undue reservation.

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Acknowledgements

This work was partly supported by the National Natural Science Foundation of China (grant no. 8227010768) and the National Key Research and Development Program of China (2021YFC2500300).

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  1. These authors contributed equally: Rui Ma, Yi Liao.

Authors and Affiliations

  1. Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Treatment of Hematological Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, China

    Rui Ma, Yi Liao, Xiao-Hui Zhang, Lan-Ping Xu, Yu Wang, Xiao-Dong Mo, Meng LV, Yuan-Yuan Zhang, Chen-Hua Yan, Yu-Hong Chen, Yao Chen, Jing-Zhi Wang, Feng-Rong Wang, Ting-Ting Han,  Jun-Kong, Zhi-Dong Wang, Wei Han, Huan Chen, Yun He, Zheng-Li Xu, Feng-Mei Zheng, Hai-Xia Fu, Kai-Yan Liu, Xiao-Jun Huang & Yu-Qian Sun

  2. Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China

    Xiao-Jun Huang

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Contributions

YQS and XJH designed this study. YL and RM conducted data analysis and drafted the manuscript. XHZ, LPX, YW, XDM, ML, YYZ, CHY, YHC, YC, JZW, FRW, TTH, JK, ZDW, WH, HC, YH, ZLX, FMZ, HXF and KYL contributed to the data preparation and interpretation. All authors approved the final version of the manuscript. All the authors contributed to the manuscript and approved the submitted version.

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Correspondence to Yu-Qian Sun.

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The authors declare no competing interests.

Ethics approval and consent to participate

The study was conducted following the Declaration of Helsinki, and the protocol was approved by the ethics committee of Peking University People’s Hospital. All patients provided written informed consent before enrollment. All methods were performed in accordance with the relevant guidelines and regulations.

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Ma, R., Liao, Y., Zhang, XH. et al. Pre-transplant disease burden rather than age or donor type was associated with survival of hematopoietic cell transplantation for elderly patients with acute myeloid leukemia. Bone Marrow Transplant 60, 107–109 (2025). https://doi.org/10.1038/s41409-024-02457-2

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