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This retrospective study analyzed data from a large\u2010scale, nationwide database in Japan. Adult patients (&gt;\u200915\u2009years old, y\/o) who received their first HSCT with FluBu4 for hematological malignancies were included. They were categorized into the younger (&lt;\u200960 y\/o, <jats:italic>N<\/jats:italic>\u2009=\u20091295) and the older group (\u2265\u200960 y\/o, <jats:italic>N<\/jats:italic>\u2009=\u2009993). The 3\u2010year overall survival (OS) rate after HSCT was significantly worse in the older group than in the other (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01, 39.9% vs. 48.5%). The 3\u2010year non\u2010relapse mortality (NRM) was significantly higher in the older group than in the other (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01, 30.9% vs. 23.0%), and the 3\u2010year cumulative incidence of relapse was comparable between them. According to the multivariate analysis, age \u2265\u200960\u2009years was significantly associated with poor OS and high NRM. In a subgroup analysis of the older group, the use of additional chemotherapeutic drugs to FluBu4 was significantly associated with poor OS and high NRM. Total body irradiation was significantly associated with high NRM and 1\u2010year incidence of sinusoidal obstruction syndrome but not with OS. Thus, FluBu4 should be used with caution in older people.<\/jats:p>","DOI":"10.1111\/ejh.14374","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T00:10:41Z","timestamp":1737418241000},"page":"852-863","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Increased Non\u2010Relapse Mortality in Older People With Allogeneic Hematopoietic Stem Cell Transplantation Using Fludarabine and Myeloablative Dose of Busulfan\u2010Based Regimen"],"prefix":"10.1111","volume":"114","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5530-6133","authenticated-orcid":false,"given":"Akihito","family":"Shinohara","sequence":"first","affiliation":[{"name":"Department of Hematology Tokyo Women's Medical University  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michiho","family":"Shindo","sequence":"additional","affiliation":[{"name":"Department of Hematology Tokyo Women's 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