Background: The number of elderly patients who could benefit from an allogeneic hematopoietic stem cell transplantation (allo-HSCT) is continuously increasing; however, the most appropriate way to select elderly candidates for this procedure is still a matter of debate.

Methods: We report the clinical outcomes of a group of 529 patients aged 65 y and older who received a first allo-HSCT between 2011 and 2020 and were reported to the Grupo Español de Trasplante Hematopoyético y Terapia Celular database.

Results: The median age was 67.2 y (range, 65-82) and 54 patients (10.2%) were 70 y and older. The 4-y cumulative incidence (CI) of nonrelapse mortality was 32.0% (95% confidence interval [CI], 28-36), CI of relapse was 29.1% (95% CI, 25-33), of overall survival was 43.4% (95% CI, 39-48), of progression-free survival was 38.9% (95% CI, 35-43), and of graft-versus-host disease (GvHD)-free, relapse-free survival was 23.7% (95% CI, 20-28). The 100-d CI of grades II-IV and III-IV acute GvHD was 34.7% (95% CI, 31-39) and 10.4% (95% CI, 8-13), respectively, and the 2-y CI of moderate-severe chronic GvHD was 21.0% (95% CI, 18-25). In the multivariate analysis, a hematopoietic cell transplantation-specific comorbidity index of ≥3 and a high/very high disease risk index were associated with worse overall survival; however, age did not influence the outcomes.

Conclusions: Advanced age alone should not serve as an exclusion criterion for allo-HSCT, as the procedure can be both safe and effective in elderly patients with careful candidate selection and optimized transplant strategies.