iwAL 2026 | Allogeneic transplantation in fit older adults with AML
Charles Craddock, CBE, FRCP(UK), FRCPath, DPhil, FMedSci, University of Birmingham, Birmingham, UK, discusses the role of allogeneic stem cell transplantation in adults over 70 years of age with acute myeloid leukemia (AML). He highlights physiological fitness and comorbidity burden rather than chronological age as key determinants of transplant suitability, supporting early donor searches and referral for fit older patients with high-risk disease. This interview took place at the 8th International Workshop on Acute Leukemias (iwAL 2026), held in Boston, MA.
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Transcript
I think in the last 10 years, there’s been increasing recognition that the most important determinant of how well you’re going to tolerate a transplant, in fact, predictor of your transplant-related mortality, is not your age, not your biological age, but your physiological age. Comorbidity is a very important predictor of transplant-related mortality. And the accruing data now is certainly up to the age of 75...
I think in the last 10 years, there’s been increasing recognition that the most important determinant of how well you’re going to tolerate a transplant, in fact, predictor of your transplant-related mortality, is not your age, not your biological age, but your physiological age. Comorbidity is a very important predictor of transplant-related mortality. And the accruing data now is certainly up to the age of 75. If you’re a fit adult, and by fit, I mean exercising fairly actively or cycling or going for big walks, then your transplant-related mortality would be the same as if you’re 55 or 60. So if you are a fit adult with high-risk AML, and most adults in that age group do have a poor outcome if treated with chemotherapy alone, it’s very sensible to start an early unrelated donor search, refer the patient for transplant as soon as they achieve remission in the safe knowledge that their outcome will be broadly the same as in a younger adult. Conversely, patients who are not fit, patients who have significant comorbidities at that age really don’t tolerate transplant well and should not be viewed as suitable transplant candidates.
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