Improved outcomes over time in patients aged ≥60 years undergoing allogeneic hematopoietic cell transplantation for acute lymphoblastic leukemia in first complete remission: a large study by the EBMT acute leukemia working party

Allogeneic hematopoietic cell transplantation remains an important curative treatment for patients with acute lymphoblastic leukemia (ALL). Over time, significant progress in transplant and post-transplant care has allowed the delivery of transplant to older patients. We assessed changes over time in characteristics and outcomes in patients >= 60 years with ALL using a dataset from the EBMT registry. We identified 832 adult patients, with T-cell ALL (n = 143), Philadelphia chromosome positive B-cell ALL (n = 471), or Philadelphia chromosome negative B-cell ALL, transplanted 2010-2022 in first remission irrespective of the donor type. Those included 280 patients transplanted in 2010-2015, and 552 patients transplanted in 2016-2022. Patients transplanted in recent years were slightly older, more likely to have T or Ph- B-ALL and to receive a myeloablative total body irradiation conditioning. The 2-year leukemia free survival (LFS) and overall survival (OS) increased over time from 42-55% and from 51-65%, respectively. In multivariate analysis, LFS, OS, chronic and extensive chronic graft-versus-host disease rates were better in recent years (hazard ratio[HR] 0.68, 0.71, 0.66 and 0.5, respectively). These real-world data can serve as a benchmark indicating that the opportunity for transplant for the fit elderly should be considered and offered when possible.