CD34+ Cell Selection versus Reduced-Intensity Conditioning and Unmodified Grafts for Allogeneic Hematopoietic Cell Transplantation in Patients Age >50 Years with Acute Myelogenous Leukemia and Myelodysplastic Syndrome

•MAC with CD34+ cell selection results in similar DFS and OS as RIC with unmanipulated grafts in AML and MDS.•MAC and CD34+ cell selection showed lower risk of GVHD and higher CRFS than RIC with unmanipulated grafts.•Patients with MAC and CD34+ cell selection had a lower risk of relapse compared with patients with RIC with unmanipulated grafts.•For patients with low HCT-CI, MAC with CD34+ cell selection resulted in higher OS compared with unmanipulated RIC. Reduced-intensity conditioning (RIC) and T cell depletion (TCD) through CD34+ cell selection without the use of post-transplantation immunosuppression are 2 strategies used to reduce nonrelapse mortality (NRM) in older patients after allogeneic hematopoietic cell transplantation (allo-HCT). To compare the efficacy of the RIC and TCD approaches, we evaluated the outcomes of patients age >50 years with acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) who underwent allo-HCT from an HLA-matched donor with one of these strategies. Baseline characteristics were comparable in the patients receiving TCD (n = 204) and those receiving RIC (n = 151), except for a higher proportion of unrelated donors (68% versus 40%; P