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Publications

Journal Article Epublish

PubMed: 42645796 DOI: 10.3390/hematolrep18040057

Is There Still a Role for Autologous Stem Cell Transplantation in Older Adults with AML?

Hematol Rep 18(4)

Authors: Saveria Capria, Clara Minotti, Massimo Breccia, Maria Laura Bisegna, Ida Carmosino, Patrizia Chiusolo, Luca Di Marino, Giovanni Luzi, Sabrina Mariani, Giovanni Marsili, Leonardo Marabitti, Elettra Ortu La Barbera, Lorena Scollo, Maurizio Martelli, Silvia Maria Trisolini

Affiliations

  • Department of Hematology, AOU Policlinico Umberto I-Sapienza University, 00161 Rome, Italy.
  • Hematology, Department of Translational and Precision Medicine, Sapienza University, 00161 Rome, Italy.
  • Ematologia e Trapianto, Dipartimento di Scienze Ematologiche e di Laboratorio, Fondazione Policlinico Universitario A. Gemelli IRCCS, Sezione di Ematologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
  • UOC Ematologia e Trapianto di Cellule Staminali, San Camillo-Forlanini Hospital, 00152 Rome, Italy.
  • Hematology Unit, AOU Sant'Andrea, Sapienza University, 00189 Rome, Italy.
  • GIMEMA Foundation, 00182 Rome, Italy.
  • Department of Hematology, SM Goretti Hospital, University Polo Pontino, 04100 Latina, Italy.

Abstract

Introduction: Autologous stem cell transplantation (ASCT) is regaining interest as a consolidation strategy for acute myeloid leukemia (AML) patients with favorable/intermediate risk and measurable residual disease (MRD) negativity. In fit older adults, its role remains debated due to concerns regarding toxicity and stem cell collection. Aim: To evaluate the long-term outcomes of ASCT in AML patients aged ≥60 years in first complete remission (CR1). Methods: We retrospectively analyzed 43 non-M3 AML patients (median age 64, range 60-72) who underwent ASCT in CR1 across five centers (2000-2024). Risk was stratified by ELN 2017. Primary endpoints were overall survival (OS) and disease-free survival (DFS). Results: The cohort included 22 favorable-risk and 21 intermediate-risk patients. Most (88%) achieved CR1 after one induction course. Median neutrophil and platelet engraftment occurred at 13 and 15 days, respectively. Grade III/IV infections were observed in 28% of patients; transplant-related mortality was low at 4%. At a median follow-up of 77 months, 5-year OS and DFS were 51% (95% CI: 37-70%) and 47% (95% CI: 34-65%), respectively. OS was significantly superior in favorable- versus intermediate-risk patients (68% vs. 35%, p = 0.027), with a similar trend for DFS (57% vs. 35%, p = 0.07). The number of consolidation cycles did not impact survival outcomes. Conclusions: This multicenter study confirms that ASCT is a feasible and effective consolidation strategy for selected fit AML patients aged ≥60. The low mortality and encouraging survival, particularly in favorable-risk subgroups, support ASCT as a valid alternative to prolonged chemotherapy or maintenance.

MeSH

Cells, Mortality, Microscopy, Electron, Scanning Transmission, Stem Cells, Leukemia, Myeloid, Acute, Aged, Transplants, Cell Transplantation, Stem Cell Transplantation, Transplantation