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The incidences of acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) increases with age, peaking in the seventh decade.Despite improved survival in younger patients treated with cytarabine and anthracycline-based chemotherapy regimens, the prognosis for AML patients above 60 years of age is still dismal.While allogeneic hematopoietic stem cell transplantation (HCT) is the most effective curative therapy in AML and MDS this approach was regarded as unsuitable for patients beyond the age of 55 years due the increased toxicity of high dose radio/chemotherapy used for conditioning.Therefore toxicity-reduced conditioning protocols were developed for successful engraftment, with considerable antileukemic activity suited for allogeneic HCT for comorbid or older patients.Outcomes particularly in patients presenting with advanced disease could be improved by increasing the intensity of cytotoxic agents in toxicity reduced conditioning.Nowadays allogeneic HCT from related and unrelated donors as potentially curative measures can be offered to patients well beyond 70 years of age resulting not only in long-term disease control but also sustained good quality of life.