DP101 | STILL A ROLE FOR AUTOLOGOUS STEM CELL TRANSPLANTATION IN ELDERLY ACUTE MYELOID LEUKEMIA?

Autologous stem cell transplantation (ASCT) has regained interest as consolidation for acute myeloid leukemia (AML) patients with favorable or intermediate risk and negative measurable residual disease (MRD). In fit elderly patients, intensive chemotherapy remains advisable, however, in this population ASCT has been limited by stem cell harvest failure, early relapse, and patient refusal. Recent advances in risk stratification and fitness assessment call for a reevaluation in this setting. Aim: To evaluate long-term outcomes of ASCT in AML patients aged ≥60 years in first complete remission (CR1). Methods: We retrospectively analyzed non-M3 AML patients aged ≥60 who underwent ASCT in CR1 across five centers between 2010–2024. Molecular profile and ELN 2022 risk assessment were required. Primary endpoints were overall survival (OS) and disease-free survival (DFS); secondary endpoints included transplant-related mortality (TRM), engraftment kinetics, and non-hematologic toxicities. Results: Forty-three patients (22F/21M; median age 64, range 60–72) were included; 22 were favorable risk, 21 intermediate. Most (88%) achieved remission after one induction course, followed by one consolidation in 28 cases and two in 15. Median time from diagnosis to ASCT was 5 months (range 2–17). Median neutrophil and platelet engraftment times were 13 and 15 days, respectively. Among 26 evaluable patients, grade III/IV infections occurred in 19%, 2 grade III/IV non-hematologic AE were reported. At a median follow-up of 60 months (range 5–232), 19 patients remain in CR, 22 relapsed (median 8 months, range 1–108), and 2 (4%) died from transplant-related causes. Five-year OS and DFS are 51% (95% CI: 37–70%) and 47% (95% CI: 34–65%), with median OS and DFS of 61 and 19 months. OS is significantly better in favorable vs. intermediate-risk patients (68% vs. 35%, p=0.027), with a trend for DFS (57% vs. 35%, p=0.07). DFS is unaffected by the number of consolidation cycles. Conclusion: This real-world, multicenter study confirms ASCT is feasible and effective in selected AML patients aged ≥60, offering promising survival, low TRM, and preserved post-transplant quality of life. Favorable-risk patients achieved encouraging outcomes, supporting ASCT as a valid consolidation strategy. Further prospective studies, including a comparison with novel maintenance approaches, are warranted.