Reduced-intensity conditioning allogeneic stem cell transplantation for older adults: Is it the standard of care?

Purpose of review: We reviewed reduced-intensity hematopoietic cell transplantation for older patients in the context of recently published studies. Recent findings: Most studies describe applicability of reduced-intensity transplantation to older patients with overall survival rates that compare favorably to chemotherapy alone, though relapse and graft-versus-host disease remain complicating factors. Though transplant recipients likely represent a highly selected population, current studies do not demonstrate an upper age for transplantation and suggest that myeloablative regimens may be considered in older patients with limited comorbidities. Avenues being pursued to improve transplant outcomes include natural killer cell immunotherapy and regulatory T-cell modulation. Summary: Until prospective studies show otherwise, transplant conditioning intensity for the older patient should be based on individual patient and disease characteristics. Enrollment into clinical trials is paramount in efforts to reduce transplant-related mortality and improve outcomes.