Schetelig Johannes, Bornhäuser Martin, Schmid Christoph, Hertenstein Bernd, Schwerdtfeger Rainer, Martin Hans, Stelljes Matthias, Hegenbart Ute, Schäfer-Eckart Kerstin, Füssel Monika, Wiedemann Barbel, Thiede Christian, Kienast Joachim, Baurmann Herrad, Ganser Arnold, Kolb Hans Jochem, Ehninger Gerhard
Medizinische KIinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.
J Clin Oncol. 2008 Nov 10;26(32):5183-91. doi: 10.1200/JCO.2007.15.5184. Epub 2008 Sep 2.
In patients with acute myeloid leukemia (AML), differential indications for matched sibling and unrelated hematopoietic stem-cell transplantation (HCT) are considered, and arbitrary age limits for HCT exist. We sought to determine whether donor type is a prognostic factor in elderly patients in the era of high-resolution DNA-based HLA typing.
We performed univariate and multivariate analyses of event-free survival (EFS) and overall survival (OS) in patients older than 50 years with standard- or high-risk AML who had received an allogeneic HCT between 1995 and 2005. Available DNA from donors and recipients of unrelated HCT was retyped so that the HLA-A, -B, -C, and -DRB1 alleles could be characterized in detail. Unrelated donors (UDs) were classified as matched (8/8), possibly matched (matched, but incomplete information), partially matched (one mismatch), or poorly matched (two or more mismatches) according to the final typing results.
Data from 368 patients with a median age of 57 years (range, 50 to 73 years) were included. Multivariate Cox regression analysis revealed that patients' disease status at HCT (P < .001) and the cytogenetic risk (P < .001) highly significantly predicted EFS and OS. Compared with patients with matched sibling donors, the adjusted relative risk of EFS was 0.7 (95% CI, 0.4 to 1.1) for patients with matched UDs and 1.0 (95% CI, 0.7 to 1.6) for patients with partially matched UDs.
Donor type is not a major prognostic factor for HCT in elderly patients with standard- or high-risk AML.
对于急性髓系白血病（AML）患者，需考虑匹配同胞和无关造血干细胞移植（HCT）的不同适应证，且HCT存在任意年龄限制。我们试图确定在基于高分辨率DNA的HLA分型时代，供者类型是否为老年患者的预后因素。
我们对1995年至2005年间接受异基因HCT的50岁以上标准或高危AML患者的无事件生存期（EFS）和总生存期（OS）进行了单因素和多因素分析。对无关HCT供者和受者的可用DNA进行重新分型，以便详细鉴定HLA-A、-B、-C和-DRB1等位基因。根据最终分型结果，无关供者（UDs）被分类为匹配（8/8）、可能匹配（匹配，但信息不完整）、部分匹配（一个错配）或错配严重（两个或更多错配）。
纳入了368例患者，中位年龄为57岁（范围50至73岁）。多因素Cox回归分析显示，HCT时患者的疾病状态（P <.001）和细胞遗传学风险（P <.001）对EFS和OS有高度显著的预测作用。与有匹配同胞供者的患者相比，匹配UDs患者的EFS调整后相对风险为0.7（95%CI，0.4至1.1），部分匹配UDs患者为1.0（95%CI，0.7至1.6）。
对于标准或高危AML老年患者，供者类型不是HCT的主要预后因素。
