Division of Hematologic Malignancies, Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA.
Biol Blood Marrow Transplant. 2010 Jun;16(6):792-800. doi: 10.1016/j.bbmt.2009.12.537. Epub 2010 Jan 13.
Reduced-intensity-conditioning (RIC) hematopoietic stem cell transplantation (HSCT) is markedly underutilized in the elderly, in part because the impact of advanced age on outcomes is poorly understood. We retrospectively analyzed outcomes in 158 consecutive hematologic malignancy patients aged > or =60 years (median, 63 years; range: 60-71 years) undergoing fludarabine/busulfan-based RIC, with a median-follow-up of 34 months (range: 12.0-85.7). Multivariate analysis was undertaken for factors having an impact on outcome. For the patients aged > or =60 years, 2-year nonrelapse mortality (NRM) and relapse was 10% and 54.6%, respectively. Two-year overall and progression-free survival (OS, PFS) was 46% and 35%, respectively. Grade II-IV acute and chronic graft-versus-host disease (aGVHD, cGVHD) incidence was 19.6% and 45.9%, respectively. Comparing 110 patients aged 60-64 years versus 48 patients aged > or =65 years, 2-year NRM and relapse was 10.5% versus 8.3% (P = .84) and 53.5% versus 56.3% (P = .31), respectively. Grade II-IV aGVHD and cGVHD incidence was 19.1% versus 22.9% (P = .52) and 51.8% versus 32.5% (P = .01), respectively. Two-year OS and PFS was 49% versus 41% (P = .11) and 36% versus 35% (P = .24), respectively. In a multivariate Cox-model, high-risk disease associated with poorer PFS (hazard ratio [HR] = 2.1, P = .01) and OS (HR = 1.84, P = .03); acute myelogenous leukemia/myelodysplastic syndrome diagnosis (HR = 1.66, P = .03) and matched-related donor (HR = 1.62, P = .03) associated with poorer PFS. RIC HSCT is well tolerated, with reasonable survival in elderly patients. Age is not associated with impaired outcomes. HSCT should not be excluded solely based on advanced patient age.
降低强度的条件（RIC）造血干细胞移植（HSCT）在老年人中明显未被充分利用，部分原因是年龄对结果的影响尚不清楚。我们回顾性分析了 158 例连续的血液系统恶性肿瘤患者（年龄均大于或等于 60 岁，中位数为 63 岁，范围为 60-71 岁）接受氟达拉滨/白消安为基础的 RIC 的结果，中位随访时间为 34 个月（范围为 12.0-85.7）。对影响结果的因素进行了多变量分析。对于年龄大于或等于 60 岁的患者，2 年无复发生存率（NRM）和复发率分别为 10%和 54.6%。2 年总生存率（OS）和无进展生存率（PFS）分别为 46%和 35%。2 级-IV 级急性和慢性移植物抗宿主病（aGVHD，cGVHD）的发生率分别为 19.6%和 45.9%。比较 110 例年龄 60-64 岁的患者和 48 例年龄大于或等于 65 岁的患者，2 年 NRM 和复发率分别为 10.5%比 8.3%（P=0.84）和 53.5%比 56.3%（P=0.31）。2 级-IV 级 aGVHD 和 cGVHD 的发生率分别为 19.1%比 22.9%（P=0.52）和 51.8%比 32.5%（P=0.01）。2 年 OS 和 PFS 分别为 49%比 41%（P=0.11）和 36%比 35%（P=0.24）。在多变量 Cox 模型中，高危疾病与较差的 PFS（危险比[HR]=2.1，P=0.01）和 OS（HR=1.84，P=0.03）相关；急性髓系白血病/骨髓增生异常综合征诊断（HR=1.66，P=0.03）和匹配相关供体（HR=1.62，P=0.03）与较差的 PFS 相关。RIC HSCT 耐受性良好，老年患者的生存情况合理。年龄与预后不良无关。HSCT 不应仅因患者年龄较大而被排除。
