P151 | Outcomes and Early Complications of Allogeneic Stem Cell Transplant for Hematologic Malignancies Inpatients Over 65 Years
Year: 2025
Type: article
Abstract: Allogeneic hematopoietic stem cell transplantation(HSCT)represents a potentially curative treatment for hematologic malignancies.The clinical outcomes and toxicity profiles in elderly patients remain uncertain.In this retrospective study we enrolled 62 patients,aged ≥65 with hematologic malignancies who underwent HSCT between 2014 and 2024 at the Hematology Department of Ancona.The main objectives were to evaluate early post-transplant complications,non-relapse-mortality(NRM)and long-term-outcomes.The median age at the time of HSCT was 68 years. Most patients were diagnosed with AML (73%),followed by MDS(8%),MPN(5%)and other conditions(14%).Donors included MSD(7%),MMUD(53%)and haploidentical(40%).Conditioning regimens consisted of RIC in 73%,myeloablative-conditioning in 24% and non-myeloablative-conditioning in 3%.Specific regimens included Treosulfan-Fludarabine(29%),Thiotepa-Busulfan-Fludarabine(50%),and Busulfan-Fludarabine(13%).GvHD-prophylaxis consisted of Cyclosporine+Mycophenolate-Mofetil in over 50% of patients.Post-transplant Cyclophosphamide was used in 53% of patients,anti-thymocyte-globulin in 55%.The engraftment-rate was 92%. Acute-GvHD occurred in 58% of patients:28% having grades III-IV.Chronic-GvHD developed in 27% of patients,with severe cases observed in 30%.By day 100,98% of patients experienced complications.Severe mucositis occurred in 60% of patients. Infections were reported in 79% of patients,including bacterial(57%),viral(39%)and fungal(13%).Grade 3 infections occurred in 63%,grade≥4 in 24%.Calcineurin-inhibitor-toxicity was detected in 61% of patients:hypertension(47%),nephrotoxicity (45%)and neurotoxicity(32%).Cardiological toxicities were reported in 19% of patients,with 67% being grade≤2.The overall survival(OS)rate at 2-years was 49%,with higher rates observed in MSD recipients(75%)compared to MMUD(60%)and haploidentical donors(36%)(p=0.03).In AML-patients,a trend toward improved OS was observed with Treosulfan-based-conditioning compared to Busulfan-based,with 2-year OS rates of 70% and 39%,respectively(p=0.06).Disease-free-survival at 2years was 71%,NRM was 31% and relapse incidence was 19%.HSCT is a feasible treatment option for carefully selected elderly patients but remains associated with substantial toxicity,particularly in the first 100-days post-transplant.Treosulfan-based-conditioning appears to offer better outcomes than Busulfan-based-conditioning in AML patients,confirming a valuable approach in this subgroup.
Authors: S. Guerzoni, B. Puglisi, I. Scortechini, G. Mancini, A. Cipiciani, I. Federici, A. De Luca, X. Diko, C. A. Piro, A. Poloni, A. Olivieri, F. Saraceni
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7093123178
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