Villela Luís, Sureda Anna, Canals Carme, Sanz Miguel Angel, Martino Rodrigo, Valcárcel David, Altés Albert, Briones Javier, Gómez Marta, Brunet Salut, Sierra Jorge
Servei d'Hematologia Clínica, Hospital de la Santa Creu i Sant Pau, Antoni Maria i Claret 167, 08025 Barcelona, Spain.
Haematologica. 2003 Mar;88(3):300-5.
Patients over 60 years are frequently excluded from autologous stem cell transplantation (ASCT) programs due to a traditionally high rate of transplant-related mortality (TRM) in such indications. We evaluated the results of ASCT in a group of 49 patients >= 60 years of age [32 males, median age 63 years (range, 60 to 71)] autografted in our institution from January 1995 to December 2001.
There were 27 patients with multiple myeloma, 13 with non-Hodgkin's lymphoma, 3 with acute myelogenous leukemia, 3 with chronic myelogenous leukemia and 3 with other hematological malignancies. The Karnofsky score was >= 80% in 47 cases. The median time from diagnosis to ASCT was 12 months (range, 5 to 61). Twenty-four patients were autografted in an early disease phase and 25 (51%) in an advanced phase. Peripheral blood stem cells were used in 46 patients (94%), bone marrow in one (2%) and bone marrow plus peripheral blood in two (4%). Forty-one patients received chemotherapy-only conditioning regimens, while only 8 patients received total body irradiation.
Engraftment occurred in all but one patient. The median times to achieve a sustained absolute neutrophil count > 0.5 x 10(9)/L and a sustained platelet count >20 x 10(9)/L were 13 (range, 10 to 35) and 13 days (range, 8 to 62), respectively. The actuarial 2-year overall survival was 67% [95% confidence interval (CI), 52-82%). Four patients died without progression due to central nervous system (CNS) hemorrhage (n = 1), CNS toxicity (n = 1), fungal infection (n = 1) or toxoplasmosis (n = 1). One hundred-day and 1-year actuarial TRM were 4% (95% CI, 1-16%) and 8% (95% CI, 3-21%), respectively.
ASCT is a feasible procedure in selected elderly patients, with apparently similar rates of engraftment and TRM to those reported for younger patients.
由于在这类患者中传统上移植相关死亡率（TRM）较高，60岁以上的患者常被排除在自体干细胞移植（ASCT）项目之外。我们评估了1995年1月至2001年12月在我们机构接受自体移植的49例年龄≥60岁患者（32例男性，中位年龄63岁，范围60至71岁）的ASCT结果。
其中27例为多发性骨髓瘤患者，13例为非霍奇金淋巴瘤患者，3例为急性髓性白血病患者，3例为慢性髓性白血病患者，3例为其他血液系统恶性肿瘤患者。47例患者的卡氏评分≥80%。从诊断到ASCT的中位时间为12个月（范围5至61个月）。24例患者在疾病早期接受自体移植，25例（51%）在疾病晚期接受移植。46例患者（94%）使用外周血干细胞，1例（2%）使用骨髓，2例（4%）使用骨髓加外周血。41例患者接受仅含化疗的预处理方案，而仅8例患者接受全身照射。
除1例患者外，所有患者均实现造血重建。达到持续绝对中性粒细胞计数>0.5×10⁹/L和持续血小板计数>20×10⁹/L的中位时间分别为13天（范围10至35天）和13天（范围8至62天）。2年总生存率的精算值为67%[95%置信区间（CI），52 - 82%]。4例患者无疾病进展而死亡，原因分别为中枢神经系统（CNS）出血（1例）、CNS毒性（1例）、真菌感染（1例）或弓形虫病（1例）。100天和1年的精算TRM分别为4%（95%CI，1 - 16%）和8%（95%CI，3 - 21%）。
ASCT在部分老年患者中是可行的，其造血重建率和TRM与年轻患者报告的情况明显相似。
