ORIGINAL RESEARCH article
Front. Oncol.
Sec. Hematologic Malignancies
Microtransplantation improves the outcome of older patients with newly diagnosed acute myeloid leukemia: a single-centre study with long-term follow-up
Provisionally accepted
- 1Chinese People's Liberation Army Rocket Force Characteristic Medical Center, Beijing, China
- 2Beijing Jiaotong University College of Life Sciences and Bioengineering, Beijing, China
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Background: Microtransplantation (MST) combines chemotherapy with infusion of HLA-mismatched granulocyte colony-stimulating factor-mobilized peripheral blood stem cells (G-PBSCs) without graft-versus-host disease (GVHD) prophylaxis, offering a potential therapeutic alternative for older acute myeloid leukemia (AML) patients. Methods: In this single-center study, 29 patients aged ≥60 years with newly diagnosed AML (non-acute promyelocytic leukemia) received MST between April 2008 and June 2021. Patients were stratified into two age cohorts: 60–70 years (n=20) and >70 years (n=9). Each MST course comprised induction or consolidation chemotherapy followed by G-PBSC infusion. Donor chimerism was monitored by InDels assay. Endpoints included complete remission (CR), overall survival (OS), leukemia-free survival (LFS), relapse, non-relapse mortality (NRM), and safety. Competing-risk analysis (Fine-Gray model) was used to evaluate cumulative incidence of relapse and NRM. Transcriptomic profiling was performed in a subset of long-term survivors. Results: The median follow-up was 148.5 months (range 52.96-219.12). The CR rate was 86.2% (25/29), with no significant difference between age groups (90.0% vs 66.7%, p = 0.290). The median OS was 20.00 months (range 1.00–205.00). Patients aged 60–70 years had significantly better OS than those >70 years (50.0% vs 10.0%, p = 0.002). Similarly, LFS was higher in the younger group (45.0% vs 10.0%, p = 0.015). Receiving >3 MST courses was associated with longer OS and LFS (both p < 0.001). Competing-risk analysis showed a significantly higher cumulative incidence of relapse in the >70-year group (66.7% vs 45.0%, p = 0.048). NRM did not differ significantly between groups (p = 0.13). GVHD occurred in one patient (3.4%). Transcriptomic analysis of four survivors revealed distinct gene-expression profiles enriched in immune and hematopoietic pathways. Conclusion: MST is an effective and tolerable treatment for older AML patients, particularly those aged 60–70 years and those receiving more than three treatment courses. These results support MST as a viable alternative for older patients ineligible for intensive transplantation (Figure 1).
Keywords: a single-centre study, Acute Myeloid Leukemia, long-term follow-up, Microtransplantation, older patients
Received: 04 Nov 2025; Accepted: 02 Feb 2026.
Copyright: © 2026 Liu, Huang, Li, Zhu, Lv, Yang, Tian and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Tian Tian
Wanjun Sun
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