Allogeneic hematopoietic cell transplantation (allo-HCT) with reduced intensity conditioning (RIC) is an option for elderly patients with acute lymphoblastic leukemia (ALL). We retrospectively compared results of RIC-allo-HCT from either a matched sibling donor (MSD, n = 209) or matched unrelated donor (MUD, n = 209) with autologous (auto, n = 142) HCT for patients aged 55 years or more treated in first complete remission (CR1) between 2000 and 2018. The probabilities of leukemia-free survival (LFS) at 5 years were 34% for RIC-allo-HCT versus 39% for auto-HCT (p = 0.11) while overall survival (OS) rates were 42% versus 45% (p = 0.23), respectively. The incidence of relapse (RI) and non-relapse mortality (NRM) was 41% versus 51% (p = 0.22) and 25% versus 10% (p = 0.001), respectively. In a multivariate model, using auto-HCT as reference, the risk of NRM was increased for MSD-HCT (Hazard ratio [HR] = 2.1, p = 0.02) and MUD-HCT (HR = 3.08, p < 0.001), which for MUD-HCT translated into a decreased chance of LFS (HR = 1.55, p = 0.01) and OS (HR = 1.62, p = 0.008). No significant associations were found with respect to the risk of relapse. We conclude that for patients with ALL in CR1, aged above 55 years, auto-HCT may be considered a transplant option alternative to RIC-allo-HCT, although its value requires verification in prospective trials.

ASST Papa Giovanni XXIII Hematology and Bone Marrow Transplant Unit Bergamo Italy

CHU de Lille LIRIC INSERM U995 Université de Lille Lille France

Département d'Hématologie Clinique CHU Lapeyronie Montpellier France

Department of Bone Marrow Transplantation and Onco Hematology Maria Sklodowska Curie National Research Institute of Oncology Gliwice Branch Gliwice Poland

Department of Hematology and Oncology University Hospital Pilsen Pilsen Czech Republic

Dept of Hematology Hôpital Saint Antoine Paris France

Dept of Hematology University Hospital Gasthuisberg Leuven Belgium

Dept of Medicine Hematology Oncology University of Freiburg Freiburg Germany

Erasmus MC Cancer Institute University Medical Center Rotterdam Netherlands

European Society for Blood and Marrow Transplantation Paris Study Office CEREST TC Paris France

Gustave Roussy Cancer Campus Paris France

Hematology Division Chaim Sheba Medical Center Tel Hashomer Israel

Hopital d'Enfants CHU de Dijon Service Hematologie Adultes Dijon France

Leukaemia Myeloma Units Royal Marsden Hospital London UK

Programme de Transplantation and Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille Institut Paoli Calmettes Marseille France

Service d'Hematologie et Therapie Cellulaire CHU Bordeaux Bordeaux France

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