DO, University of Minnesota, Division of Hematology, Oncology and Transplantation, University of Minnesota, MMC 480, 420 Delaware St SE, Minneapolis, MN 55455, USA.
J Clin Oncol. 2010 Apr 10;28(11):1878-87. doi: 10.1200/JCO.2009.25.4821. Epub 2010 Mar 8.
PURPOSE Acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) primarily afflict older individuals. Hematopoietic cell transplantation (HCT) is generally not offered because of concerns of excess morbidity and mortality. Reduced-intensity conditioning (RIC) regimens allow increased use of allogeneic HCT for older patients. To define prognostic factors impacting long-term outcomes of RIC regimens in patients older than age 40 years with AML in first complete remission or MDS and to determine the impact of age, we analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR). PATIENTS AND METHODS We reviewed data reported to the CIBMTR (1995 to 2005) on 1,080 patients undergoing RIC HCT. Outcomes analyzed included neutrophil recovery, incidence of acute or chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), relapse, disease-free survival (DFS), and overall survival (OS). RESULTS Univariate analyses demonstrated no age group differences in NRM, grade 2 to 4 acute GVHD, chronic GVHD, or relapse. Patients age 40 to 54, 55 to 59, 60 to 64, and > or = 65 years had 2-year survival rates as follows: 44% (95% CI, 37% to 52%), 50% (95% CI, 41% to 59%), 34% (95% CI, 25% to 43%), and 36% (95% CI, 24% to 49%), respectively, for patients with AML (P = .06); and 42% (95% CI, 35% to 49%), 35% (95% CI, 27% to 43%), 45% (95% CI, 36% to 54%), and 38% (95% CI, 25% to 51%), respectively, for patients with MDS (P = .37). Multivariate analysis revealed no significant impact of age on NRM, relapse, DFS, or OS (all P > .3). Greater HLA disparity adversely affected 2-year NRM, DFS, and OS. Unfavorable cytogenetics adversely impacted relapse, DFS, and OS. Better pre-HCT performance status predicted improved 2-year OS. CONCLUSION With these similar outcomes observed in older patients, we conclude that older age alone should not be considered a contraindication to HCT.
急性髓系白血病（AML）和骨髓增生异常综合征（MDS）主要影响老年人。由于对发病率和死亡率过高的担忧，通常不提供造血细胞移植（HCT）。降低强度的调理（RIC）方案允许增加对年龄较大的患者进行同种异体 HCT。为了确定影响年龄在 40 岁以上首次完全缓解的 AML 或 MDS 患者 RIC 方案长期结果的预后因素，并确定年龄的影响，我们分析了国际血液和骨髓移植研究中心（CIBMTR）的数据。
我们回顾了向 CIBMTR（1995 年至 2005 年）报告的 1080 例接受 RIC HCT 的患者的数据。分析的结果包括中性粒细胞恢复、急性或慢性移植物抗宿主病（GVHD）、非复发死亡率（NRM）、复发、无病生存（DFS）和总生存（OS）。
单因素分析显示，NRM、2 至 4 级急性 GVHD、慢性 GVHD 或复发在各年龄组之间无差异。年龄在 40 至 54、55 至 59、60 至 64 和 > = 65 岁的患者 2 年生存率分别为：AML 患者为 44%（95%CI，37%至 52%），50%（95%CI，41%至 59%），34%（95%CI，25%至 43%）和 36%（95%CI，24%至 49%）（P =.06）；MDS 患者为 42%（95%CI，35%至 49%），35%（95%CI，27%至 43%），45%（95%CI，36%至 54%）和 38%（95%CI，25%至 51%）（P =.37）。多因素分析显示年龄对 NRM、复发、DFS 或 OS 无显著影响（均 P >.3）。HLA 差异较大对 2 年 NRM、DFS 和 OS 有不利影响。不良细胞遗传学对复发、DFS 和 OS 有不利影响。预处理时的较好表现状态预测 2 年 OS 较好。
在观察到年龄较大的患者有类似的结果，我们得出结论，仅年龄较大本身不应该成为 HCT 的禁忌症。
