Improved results of allogeneic transplantation in elderly patients with acute myeloid leukaemia since the 2000s

A cute myeloid leukaemia (AML) mainly affects elderly patients, with a median age at diagnosis of 68 years. Historically, patients over 65 years of age had poor outcomes with allogeneic haematopoietic stem cell transplantation (allo-CSH) due to its high toxicity. However, over the last two decades, we have seen significant progress in the treatment of AML in elderly patients, thanks to the use of less toxic targeted therapies and the use of reduced-intensity conditioning regimens, which have particularly improved the feasibility of allograft transplantation in elderly patients by reducing non-relapse mortality. In addition, improvements in supportive care, including haematopoietic growth factors and new generations of antibiotics, antivirals and antifungals, have also helped to reduce NRM. Several recent studies have shown an impressive improvement over time in outcomes after allo-CSH in elderly subjects, thanks to a reduction in the relapse rate, regardless of the state of the disease at the time of transplantation. These results have constantly improved, particularly for patients in complete remission, despite a spectacular increase in the number of elderly patients receiving allografts. These data highlight the importance of allo-CSH as a feasible curative option, which should be routinely offered to elderly patients with AML.