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Originally published June 30, 2026
Last updated June 30, 2026
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Acute myeloid leukemia (AML) is a rare, aggressive cancer that affects the blood and bone marrow. Accounting for about 1% of all cancers, AML more commonly affects older adults. The average age at diagnosis is 69, according to the American Cancer Society.
One of the most effective treatment strategies for AML is a bone marrow transplant, also called a stem cell transplant, which involves delivering healthy bone marrow cells into the bloodstream. It’s typically performed after chemotherapy and radiation treatments are complete, and the recovery can be extensive.
“As we tell patients, a bone marrow transplant isn’t a walk in the park but it’s the best approach to get a cure,” says George Yaghmour, MD, a hematologist specializing in stem cell transplants with the USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC.
There are no strict bone marrow transplant age restrictions. However, as Dr. Yaghmour explains, younger patients tend to have better outcomes compared to older adults.
A primary reason, he says, is that older patients tend to present with more severe forms of AML. “As a general rule, the biology of the leukemia and the risk of recurrence are higher in older ages,” Dr. Yaghmour says. Elderly adults are also more likely to have refractory disease, which means the cancer stops responding to therapies.
There is the risk of graft-versus-host disease (GVHD), which occurs when the donor cells attack the patient’s organs. As Dr. Yaghmour explains, elderly patients often receive less intensive chemotherapy compared to younger adults. This increases their risk for GVHD.
Another factor is that with advanced age, it can be harder for the body to recuperate enough after chemotherapy and radiation to withstand a bone marrow transplant. “Age always carries more DNA damage, and the ability to repair is more challenging,” Dr. Yaghmour says. “When patients get older, their organ and muscle recovery is more difficult.”
However, age alone doesn’t determine bone marrow transplant eligibility.
Patients in remission have a higher likelihood of achieving a long-term cure from the transplant. Additionally, since chemo and radiation can be hard on vital organs, doctors consider the patient’s heart, lung, liver and kidney function.
At the same time, treatment advancements are making bone marrow transplants more effective in older adults and expanding eligibility. While Dr. Yaghmour says it’s rare for patients in their 80s to undergo a transplant, he’s successfully performed the procedure on adults in their late 70s.
“We have designed non-ablative, less-intensive approaches that offer transplant with minimal toxicity,” Dr. Yaghmour says. He adds that T-cell depletion techniques can reduce the risk of GVHD, and advancements in antimicrobial technology are improving infection detection.
Dr. Yaghmour emphasizes that the recovery after a bone marrow transplant isn’t easy, requiring a high level of extended multidisciplinary care. Since the transplant effectively shuts down the body’s natural immune responses, there is an increased risk of infection for at least the first several months after surgery. Side effects can also include severe fatigue, reduced muscle mass, loss of appetite and nausea.
But, he says, a transplant can be well worth it because it can give the patients valuable time. “Without the transplant, risk of relapse can be more than 60%. With a transplant, you reduce that risk to 30%,” he explains.
“A bone marrow transplant buys a few extra years,” Dr. Yaghmour adds. “If a patient has a wedding or a graduation that they want to be here for, two or three years from now, then a bone marrow transplant is their best way to achieve long-term remission and get there.”
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