Abstract Body

Allogeneic bone marrow transplantation (BMT) is one of the most effective therapies for hematological malignancies, but complications strongly impact the outcome of patients. These weaknesses increase with age and have long conducted to discard transplantations in older population. Over years tremendous progresses have been achieved in this field including lower toxicity preparative regimen, better supportive care, better GVHD prophylaxis and larger possibilities of donor eligibilities. Altogether these ameliorations have gradually invited to consider more older patients for transplant with improved results. However, the game is not over. Some of the improvements related to safer approaches have been associated with some loss in disease control. The use of mismatched related donor is also associated with some drawbacks concerning disease control. The present challenge is thus the needs for optimizing the procedure with an optimal balance between safety and disease control. Better characterizations of disease and patient realities are mandatory to do so. Tools have been successfully developed in both fields and requests to be used concomitantly. Initial genomics, response to treatment evaluated by measurable residual disease (MRD) determination prior to transplant deliver very important information concerning disease status. Post-transplant MRD as well as Donor chimerism status are also very important tools to drive post-transplant treatment strategies. On the other hand, chronologic age is not anymore, the relevant parameter allowing a good assessment of patient situation. The use of geriatric assessment, in combination with evaluation of comorbidities and social vulnerability allow for better tuning of the transplant procedure. Altogether these different parameters combined in an individual personalized approach will allow for better outcome in this population of older patients with scarce outcome without transplant. This is notably the case of patients suffering from MDS