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

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.