Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients (≥ 70 Years) with Hematologic Malignancies: A Community Center Experience

Background: Many hematologic malignancies, including leukemia (AML/CML), myelodysplastic syndrome (MDS), and aplastic anemia, predominantly affect older adults. Allogeneic hematopoietic stem cell transplantation (AHSCT) offers a potential cure for intermediate- to high-risk disease. However, it is infrequently offered to patients older than 70 due to concerns about tolerability. Methods: With advancements in graft-versus-host disease (GVHD) management and reduced-intensity conditioning regimens, we conducted a retrospective study of patients ≥ 70 years of age who underwent AHSCT at Advocate Lutheran General Hospital from 2019 to 2024. A total of 31 patients were identified, with a median age of 72. Among them, 20 had AML/CML, 8 had MDS, and 2 had aplastic anemia. Results: Relapse-free survival (RFS) rates at 100 days, one year, two years, and three years were 70.71%, 41.67%, 35.26%, and 35.26% respectively. Overall mortality was attributed to three primary causes: sepsis (35%), GVHD (35%), and relapse (30%). The 100-day treatment-related mortality rate was 29%, with causes of death including relapse (3 cases), GVHD (1 case), and sepsis (5 cases). Further analysis of pre-transplant bone marrow pathology, cytogenetics, and molecular genetic risk factors found no significant differences between survivors and non-survivors or among primary causes of death, suggesting that pre-transplant pathological and genetic risk did not significantly influence the causes of mortality seen at our community center. Conclusions: AHSCT in elderly patients remains a challenge. Further studies are needed to refine patient selection criteria, identify key demographic and oncologic risk factors, and improve outcomes in this population.