Background and Objectives: The optimal treatment strategy for older patients with acute myeloid leukemia (AML) remains uncertain because treatment selection is influenced by age, comorbidity, functional status, and disease biology. This study explored real-world outcomes with intensive and non-intensive treatment strategies. Materials and Methods: We retrospectively analyzed 69 patients aged ≥ 65 years diagnosed with AML between 2012 and 2022 at a tertiary center. Treatment intensity was defined by regimen. Baseline demographic, clinical, and laboratory parameters were recorded. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan–Meier method and compared using log-rank tests. Results: A total of 69 patients were included, with a median age of 71 years. Intensive and non-intensive therapies were administered in 24.2% and 75.8% of treated patients, respectively. The median PFS was 6.7 months, and the median OS was 7.8 months. One- and two-year OS rates were 29% and 9.2%, respectively. No significant differences in PFS or OS were observed between treatment intensity groups. Among response-evaluable patients, complete remission/complete remission with incomplete hematologic recovery (CR/CRi) was achieved in 58.0% of intensively treated patients and 43.3% of those receiving hypomethylating agent (HMA)-based therapy. Among the evaluated baseline variables, only Eastern Cooperative Oncology Group (ECOG) performance status was significantly associated with overall survival. Patients with an ECOG performance status ≥ 2 had significantly shorter OS than those with ECOG <2 (median OS: 4.85 vs. 8.60 months, p = 0.009). Conclusions: In this real-world cohort of older patients with AML, no statistically significant differences in PFS or OS were observed between intensive and non-intensive treatment strategies. Although CR/CRi rates were numerically higher with intensive therapy, disease progression remained frequent among patients who achieved a response. ECOG performance status was significantly associated with overall survival, highlighting the relevance of functional status in individualized treatment selection. These findings should not be interpreted as evidence of therapeutic equivalence.

Objective: Acute leukemia often involves comorbidities, impacting treatment decisions and patient outcomes. Clinicians commonly use the Charlson Comorbidity Index (CCI) and the Hematopoietic Stem Cell Transplantation Comorbidity Index (HCT-CI) to assess their influence. However, their effectiveness in predicting survival and non-relapse mortality (NRM) in acute leukemia patients under 65 undergoing allogeneic stem cell transplantation remains unclear. Patients and Methods: We conducted a retrospective single-center analysis on adults diagnosed with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL). The study included 35 patients, comprising 16 AML and 19 ALL cases. Patients were categorized based on age-adjusted HCT-CI and CCI scores. Results: The 2-year NRM rate was determined to be 51.4%. Statistical analysis found no significant associations between age-adjusted CCI (p=0.217) and age-adjusted HCT-CI (p=0.102) with NRM. However, median overall survival significantly varied based on risk levels (p=0.003), HCT-CI groups (p=0.009), and CCI groups (p=0.011). Conclusion: Using age-adjusted HCT-CI and CCI for comorbidity scoring in initial assessment of acute leukemia patients and those under 65 shows promise. However, these indices were ineffective in predicting NRM, emphasizing the importance of considering other significant pre-transplant factors like genetic risk, conditioning regimens, and donor type.