Allogeneic stem cell transplantation with HLA-matched donors is increasingly used for older patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). It remains unclear if haploidentical stem cell transplantation (haploSCT) is a suitable option for older patients with this disease. We analyzed 43 patients with AML/MDS (median age, 61 years) who underwent a haploSCT at our institution. All patients received a fludarabine-melphalan-based reduced-intensity conditioning regimen and post-transplant cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis. Except for 1 patient who had early death, the remaining 42 patients (98%) engrafted donor cells. The cumulative incidences of grades II to IV and III to IV acute GVHD at 6 months were 35% and 5%, respectively, and chronic GVHD at 2 years was 9%. After a median follow-up of 19 months, 2-year overall survival, progression-free survival (PFS), and relapse incidence were 42%, 42%, and 24%, respectively. Best PFS (74% at 2 years) was seen in patients with intermediate-/good-risk cytogenetics, in first or second remission (hazard ratio, .4; P = .05), and with a younger donor (≤40 years; hazard ratio, .2; P = .01). In conclusion, these data suggest that haploidentical transplantation is safe and effective for older AML/MDS patients. Disease status, cytogenetics, and younger donor age are predictors for improved survival in older patients receiving a haploidentical transplant.

High-dose therapy followed by autologous hematopoietic stem cell (HSC) transplant is considered standard of care for eligible patients with multiple myeloma. The optimal collection strategy should be effective in procuring sufficient HSC while maintaining a low toxicity profile. Currently available mobilization strategies include growth factors alone, growth factors in combination with chemotherapy, or growth factors in combination with chemokine receptor antagonists; however, the optimal strategy has yet to be elucidated. Herein, we review the risks and benefits of each approach.

Allogeneic hematopoietic stem cell transplantation (ASCT) is an effective consolidative strategy to decrease relapse for patients with acute myeloid leukemia (AML) and can cure ;30% to 50% of patients with AML. 1,2 It has been recognized that survival can vary widely after transplant based on differences in population studied. 3 Pivotal historical studies have shown that remission status at the time of transplant, cytogenetics, age, HLA matching, performance status, and comorbidity indices have prognostic utility. [4][5][6][7] However, potential interactions among these factors have not been explored.Herein, we hypothesized that the combination of disease and patient characteristics will better predict prognosis in patients receiving ASCT, and tested this hypothesis in a homogenous group of haploidentical transplant (HaploSCT) patients.Patients with a diagnosis of AML/myelodysplastic syndrome (MDS) who received first HaploSCT between September 2009 and March 2015 were retrospectively evaluated. After a retrospective data review protocol and a waiver of informed consent was obtained from The MD Anderson Cancer Center (MDACC) Institutional Review Board, clinical and demographic information was obtained. Data collection included patient/ donor demographics, cytomegalovirus (CMV) serostatus, cytogenetics according to SWOG/Eastern Cooperative Oncology Group (ECOG) cytogenetic risk, 8 Hematopoietic Cell Transplant-Comorbidity Index (HCT-CI) score, 6 source of stem cells (peripheral blood or bone marrow [BM]), and natural killer (NK) cell alloreactivity (killer immunoglobulinlike receptor [KIR]-ligand mismatch). Disease status was categorized as first or second complete remission (CR1, CR2) defined as #5% BM blasts (with or without count recovery, with or without minimal residual disease [MRD]), or beyond CR1/CR2.All patients received a conditioning regimen composed of 160 mg/m 2 fludarabine, 100 to 140 mg/m 2 melphalan, and 5 mg/kg thiotepa or 2 Gy total body irradiation as previously described. 9 Graft-versus-host disease (GVHD) prophylaxis consisted of 50 mg/kg cyclophosphamide on day 13 and 14, mycophenolate mofetil until day 1100, and tacrolimus until 6 months posttransplant, unless otherwise indicated. All patients received departmentally standardized antimicrobial prophylaxis. 9 Patient demographics are reported with descriptive statistics. Primary outcome of interest was progression-free survival (PFS), and secondary outcomes included overall survival (OS) and disease progression. Actuarial PFS and OS were estimated using the Kaplan-Meier method. 10 The cumulative incidence of disease progression was estimated accounting for competing risks. Predictors of PFS were evaluated on univariate analysis using Cox proportional hazards regression analysis. 11 To account for potential interaction and assess the

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