Editor's Note: The “Gaobo Medical Forum—6th Clinical Application Seminar and Training Course on Autologous Hematopoietic Stem Cell Transplantation,” hosted by the National Clinical Research Center for Hematologic Diseases of the Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, and organized by Shanghai Zhaxin Hospital/Gaobo Medical Group and Shanghai Liquan Hospital, was held in Shanghai on August 29–30, 2026. During the meeting, Oncology Frontier – Hematology Frontier invited Dr. Huixia Liu, Director of the Transplant Ward at Gaobo Shanghai Zhaxin Hospital, to provide a comprehensive analysis and share clinical experience on the challenging issue of allogeneic transplantation for older patients with acute leukemia, covering patient assessment, optimization of conditioning regimens, and post-transplant management.Oncology Frontier – Hematology Frontier: In recent years, an increasing number of older patients with acute leukemia have undergone allogeneic transplantation, and age is no longer considered an absolute contraindication. In clinical practice, how should we determine eligibility for transplantation in older patients? Beyond age, which comorbidities and organ-function parameters are the most important considerations during assessment?
Dr. Huixia Liu: In recent years, the number of patients aged over 70 years with acute myeloid leukemia (AML) undergoing allogeneic hematopoietic stem cell transplantation has been increasing annually in Western countries and Japan. This demonstrates that age itself is not an absolute contraindication to transplantation. As China gradually enters an aging society, an increasing number of older patients with hematologic diseases require allogeneic transplantation as potentially life-saving treatment. For older patients, a multidimensional comprehensive assessment system has been established in clinical practice, incorporating the Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI), ECOG performance status, comprehensive geriatric assessment (CGA), and organ-function evaluation to comprehensively balance the risks and benefits of transplantation.
Beyond age, the core factors considered by our center when evaluating transplantation eligibility in older patients mainly include physical performance status, HCT-CI score, and cognitive function.
Oncology Frontier – Hematology Frontier: Reduced-intensity conditioning (RIC) is currently the main choice for transplantation in older patients with acute leukemia. Compared with myeloablative conditioning, how should the trade-offs in efficacy, toxicity, and relapse risk be considered? In your clinical practice, what individualized adjustments do you make to conditioning regimens for older patients?
Dr. Huixia Liu: For older patients undergoing transplantation, reduced-intensity conditioning (RIC) or non-myeloablative conditioning (NMA) regimens are generally used internationally. This is mainly because older patients typically have a higher burden of comorbidities and poorer physical performance status. Because myeloablative conditioning (MAC) regimens are more intensive, they can result in a higher incidence of early transplant-related mortality, limiting their application in this population.
In clinical practice, our center primarily uses reduced-intensity conditioning regimens, with some patients receiving non-myeloablative conditioning. The transplant conditioning intensity (TCI) score is generally maintained at approximately 1.5–2 points. During conditioning, we make individualized adjustments according to each patient’s specific circumstances, including differences in organ function.
Oncology Frontier – Hematology Frontier: After transplantation, older patients face multiple risks, including graft-versus-host disease, infection, organ injury, and disease relapse. Compared with younger patients, what specific management considerations should receive particular attention during post-transplant follow-up and prevention in older patients? What areas of allogeneic transplantation for older patients with acute leukemia are worth exploring in the future?
Dr. Huixia Liu: Compared with younger patients, the follow-up and management of older patients after allogeneic hematopoietic stem cell transplantation require physicians to devote considerably more time and effort. Based on our clinical experience, the key considerations can be summarized as follows:
First, increase the frequency of follow-up. Particularly during the first 100 days after transplantation, patients require intensive follow-up to closely monitor changes in their condition.
Second, strengthen medication management and multidisciplinary collaboration. Patients routinely require various prophylactic medications after transplantation. Older patients, however, often have chronic underlying diseases and therefore need to take long-term medications for those conditions, resulting in complex drug–drug interactions. Consequently, clinicians need to be highly familiar with the characteristics of different medications and, when necessary, involve physicians from other specialties to ensure medication safety.
Third, strengthen the social support system. Older patients often require greater assistance with activities of daily living. Therefore, they need caregivers who are capable of providing continuous care and long-term support.
Fourth, pay close attention to cognitive and psychological status. Cognitive impairment can directly affect transplant outcomes and therefore requires considerable attention from clinicians. At the same time, older patients are prone to anxiety and often have significant concerns about disease relapse and their future quality of life. During follow-up, physicians should carefully monitor these patients and provide timely psychological counseling and intervention when necessary.
Looking ahead, the key focus of transplantation research in older patients with AML remains finding the optimal balance between transplant-related mortality and disease relapse. By developing more appropriate and individualized conditioning regimens, we hope to enable more older patients to achieve better long-term disease-free survival.
Expert Profile
Dr. Huixia Liu
Gaobo Shanghai Zhaxin Hospital
- Deputy Chief Physician, MD; Director of the Transplant Ward at Gaobo Shanghai Zhaxin Hospital
- Has managed more than 1,000 transplant patients as Director of the Transplant Ward at Gaobo Shanghai Zhaxin Hospital
- Former Attending Physician in the Department of Hematology at Shanghai General Hospital, with more than 10 years of experience in the diagnosis and treatment of hematologic diseases
- Has published eight articles in well-known professional journals in China and abroad, including one SCI-indexed article and seven articles in core Chinese journals
- Areas of expertise: Diagnosis and treatment of bone marrow failure disorders and myeloproliferative neoplasms; hematopoietic stem cell transplantation, including autologous and allogeneic hematopoietic stem cell transplantation and umbilical cord blood transplantation
- Main research focus: Treatment and transplantation for myelofibrosis
