Background: ASCT represents a potentially curative approach for AML and MDS, diseases that primarily affects patients in 7^th and 8^th decade of life. Here, we report outcomes of patients older than 64 treated at the MD Anderson Cancer Center from 1996 until December 2011. Methods: 182 patients older than 64 received an ASCT for AML (n=143) or MDS (n=39). Outcomes of interest were transplant-related mortality (TRM), incidence of acute and chronic graft-versus-host disease (GVHD), incidence of relapse, and overall survival (OS) - which were estimated from the date of transplant. Results: The median age of patients was 67 (range 65-79). Most patients were transplanted with active disease (table). Median follow-up for alive patients was 12.6 months (n=63; range 0-118). The cumulative incidence of 100-day, 1 year, and 3 year TRM was 14%, 18%, and 21%, respectively. 26% of patients developed grade II-IV acute GVHD and 35% suffered from chronic GVHD. The actuarial incidence of relapse was 46% at 1 year and 53% at 3 and 5 years. Actuarial OS was estimated to be 45% at 1 year, 28% at 3 years, and 21% at 5 years. 3 year OS for patients transplanted in CR and with active disease was 40% versus 23% (p=0.02). OS of patients age 65-69 or >69 was 30% vs. 20% (p=0.06) at 3 years for all patients; compared to 38% versus 27% (p=0.23) for patients in those age groups transplanted in CR. Conclusions: Although a significant minority of patients older than 64 years may achieve long-term disease control, new approaches are needed to reduce TRM and relapse in this cohort of patients.

Category	Parameter	Number (%)
Donor type	Matched related donor	87 (48)
	Matched unrelated donor	73 (40)
	Mismatched unrelated donor	17 (9)
Preparative regimens	Fludarabine/melphalan	85 (47)
	Fludarabine/busulfan	61 (34)
	Fludarabine/idarubicin	13 (7)
Immunosuppression	Tacrolimus/mini-methotrexate	147 (81)
	Tacrolimus/mycophenolate	8 (4)
	Post-transplant cyclophosphamide	16 (9)
Disease status at ASCT	Primary induction failure	21 (12)
	Complete remission 1	38 (21)
	Complete remission 2 or 3	15 (8)
	Refractory/untreated disease	120 (66)