A Single Center Real World Experience of Allogeneic HSCT of Patients with MDS/CMML in Aged Population

MDS/CMML are diseases typically observed in older individuals, and conventional intensive chemotherapy often proves ineffective for them. While treatments like HMA and promising new drugs can offer initial disease control, they do not yield high cure rates. Allogeneic HSCT (Hematopoietic Stem Cell Transplantation) has shown potential in achieving better outcomes but is underutilized in elderly patients. Concerns revolve around its perceived toxicity with traditional procedures and inefficiency with lower-intensity approaches. This hesitancy is fueled by a lack of up-to-date data specific to this population, as existing reports often combine data from both young and elderly patients or pertain to treatments administered long ago, missing out on recent advancements in transplantation.Here, we present our center's experience from 2010 to 2022. Out of 1656 patients who underwent transplantation during this period, 306 were diagnosed with MDS/CMML. Among them, 109 were aged 65 or older, categorized as follows: 65-69 years (N=70) and 70 years and older (N=39). Additionally, we will provide the characteristics of 41 patients aged 50-59 and 46 patients aged 60-64 as a point of comparison, totaling 196 patients.As time progressed, we observed a growing number of older patients undergoing transplantation, with an increasing preference for Haploidentical (Haplo) donors, as illustrated in Table 1. Furthermore, Haploidentical donors combined with post-transplant cyclophosphamide (PTCY) were more frequently employed for patients aged 65 and older, as detailed in Table 2.The outcomes of patients aged 65 and older are summarized in Table 3 and visualized in Figure 1. Notably, out of 71 patients aged 65 or older transplanted from a Haplo donor, the 3-year probabilities for Non-Relapse Mortality (NRM), relapse, Overall Survival (OS), and Leukemia-Free Survival (LFS) were 33%, 27%, 51%, and 50%, respectively (see Figure 2).In conclusion, over a span of 12 years, we have witnessed a significant increase in the age of patients diagnosed with MDS/CMML. Consequently, we have increasingly opted for non-myeloablative conditioning and Haploidentical donors. This series encompasses patients aged 65 and older, including 20% with refractory disease. With a median follow-up of 41 months (ranging from 9 to 135 months), we have achieved long-term survival and LFS rates with a plateau exceeding 40% after 4 years. Notably, transplantation results from Haplo donors exhibit similar and promising outcomes.Collectively, these data underscore the viability of allogeneic HSCT in this elderly population and advocate for ongoing improvements in transplant procedures to reduce NRM and relapse rates.