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Superior outcomes of haploidentical hematopoietic cell transplantation over chemotherapy in AML patients 55 years or older

Bone Marrow Transplantation volume 60, pages 773–778 (2025)Cite this article

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Abstract

Despite advancements in treatment, the prognosis for elderly AML patients remains poor. We conducted a retrospective study involving 307 consecutive AML patients, including 71 who underwent haploidentical hematopoietic cell transplantation (Haplo) and 236 who received chemotherapy (Chemo) only. Propensity score matching with 1:1 ratio was performed to balance the groups based on age at treatment initiation, gender, and European Leukemia Net (ELN) 2022 risk classification. 69 case-controlled pairs in the Haplo and Chemo group were analyzed after matching. The two groups were comparable concerning therapy prior to complete remission and 72.5% of patients in the Haplo group received reduced-intensity conditioning. Haplo was associated with a significant survival advantage over Chemo, with a 1-year OS of 77.9% (95% confidence interval(CI), 65.5–86.3, p = 0.001) versus 62.0% (95% CI, 47.9–73.2, p = 0.009). A significanly higher 1-year LFS of 74.1% (95% CI, 61.5–83.1) was also observed compared with 42.0% (95% CI, 29.3–54.0) in the chemotherapy group (p < 0.0001). The survival advantage was majorly due to a significantly reduced relapse incidence (Haplo: 16.5% (95% CI, 8.7–26.5) vs Chemo: 56.6% (95% CI, 42.9–68.2)). The 1-year non-relapse mortality was 9.4% (95% CI, 3.8–18.2) in the Haplo group. To conclude, haploidentical HCT showed superior outcomes to chemotherapy alone and might be recommended to AML patients 55 years or older eligible for transplant in future practice.

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Fig. 1: Comparative outcomes of chemotherapy versus haplo-HCT.
Fig. 2: Transplant outcomes.

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Data available on request from the authors.

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Acknowledgements

We would like to express our gratitude to all the patients and personnel involved in this study.

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Author notes

  1. These authors contributed equally: Lin Li, Lixia Zhu.

  2. These authors jointly supervised this work: Yishan Ye, Xi Zhang, He Huang.

Authors and Affiliations

  1. Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Lin Li, Lixia Zhu, Mengqi Xiong, Zhile Chen, Yi Luo, Jimin Shi, Yanmin Zhao, Jian Yu, Xiaoyu Lai, Lizhen Liu, Huarui Fu, Diange Jin, Guanfang Zhang, Shanshan Pei, Yue Liang, Xiujin Ye, Yishan Ye & He Huang

  2. Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China

    Lin Li, Lixia Zhu, Mengqi Xiong, Zhile Chen, Yi Luo, Jimin Shi, Yanmin Zhao, Jian Yu, Xiaoyu Lai, Lizhen Liu, Huarui Fu, Diange Jin, Guanfang Zhang, Shanshan Pei, Yue Liang, Xiujin Ye, Yishan Ye & He Huang

  3. Medical Center of Hematology, Xinqiao Hospital of Army Medical University, Chongqing, China

    Ting Chen & Xi Zhang

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Contributions

He Huang, Xi Zhang and Yishan Ye contributed to the study conception and design. Data collection and analysis were performed by Lin Li, Lixia Zhu, Mengqi Xiong and Zhile Chen. The first draft was written by Lin Li and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yishan Ye, Xi Zhang or He Huang.

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All methods were performed in accordance with the relevant guidelines and regulations. Ethical approval was obtained from the Clinical Research Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine and Medical Center of Hematology, Xinqiao Hospital of Army Medical University, Chongqing, China. Informed consent was obtained from all participants prior to their involvement in the study.

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Li, L., Zhu, L., Xiong, M. et al. Superior outcomes of haploidentical hematopoietic cell transplantation over chemotherapy in AML patients 55 years or older. Bone Marrow Transplant 60, 773–778 (2025). https://doi.org/10.1038/s41409-025-02560-y

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