Prognostic factors in patients aged 50 years or older undergoing allogeneic hematopoietic stem cell transplantation for hematologic malignancy

We retrospectively analyzed patients aged ≥ 50 years with hematologic malignancies who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) to identify preoperative variables predicting the outcome. There were 71 patients with a median age of 57 years (range: 50–63 years) who had acute leukemia (n = 53) or myelodysplastic syndrome (n = 18). Myeloablative conditioning was done in 35 patients and 36 patients had reduced-intensity conditioning. The 5-year overall survival rate (OS), cumulative relapse rate, and non-relapse mortality rate (NRM) were 45, 24, and 33%, respectively. According to multivariate analysis, high-risk disease (HR 3.50, 95% CI 1.43–8.56, P = 0.006), a hematopoietic cell transplantation comorbidity index (HCT-CI) score ≥3 (HR 4.41, 95% CI 1.31–14.77, P = 0.016), and an HLA-mismatched unrelated donor (HR 4.03, 95% CI 1.46–11.10, P = 0.007) were significant predictors of worse OS. High-risk disease was also significantly associated with a higher cumulative relapse rate (HR 4.59, 95% CI 0.94–6.92, P = 0.065). Furthermore, an HCT-CI score ≥3 (HR 3.02, 95% CI 1.01–20.78, P = 0.048) and an HLA-mismatched unrelated donor (HR 3.02, 95% CI 1.04–8.74, P = 0.042) were risk factors for NRM. These results suggest that the disease risk, HCT-CI score, and donor type/histocompatibility are prognostic factors for elderly patients, while the conditioning regimen and age are not predictors.