Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
Bone Marrow Transplant. 2011 Apr;46(4):545-51. doi: 10.1038/bmt.2010.145. Epub 2010 Jun 14.
The prognosis of elderly patients with AML after chemotherapy is poor. Allo-SCT is feasible in these patients, but data on prognostic factors and outcome are limited. We analyzed all 102 AML patients ≥55 years, who underwent allo-SCT at our institution from 1997 to 2008. OS and relapse-free survival (RFS) rates at 3 years are 39 and 37%, respectively. Multivariate analysis for OS revealed age ≥60 years and active (refractory or untreated before allo-SCT) or advanced (>CR1) disease as adverse prognostic factors. Patients transplanted in CR1 had a 3-year OS of 67 vs 27% for patients with active/advanced disease. Multivariate analysis for RFS revealed active/advanced disease as the only adverse factor. Patients transplanted in CR1 had a 3-year RFS of 70 vs 22% for patients with active/advanced disease. In all, 17% of patients suffered from acute GVHD ≥grade II. The risk for severe acute GVHD was increased after allo-SCT from mismatched donors. Nonrelapse mortality (NRM) was 23% at 1 year. The only risk factor for NRM was active/advanced disease. In conclusion, allo-SCT from related or unrelated donors yields very good results in elderly AML patients transplanted in CR1. Disease status at transplantation is the most important prognostic factor for transplantation success.
老年 AML 患者在化疗后的预后较差。allo-SCT 对这些患者是可行的，但关于预后因素和结果的数据有限。我们分析了 1997 年至 2008 年在我们机构接受 allo-SCT 的所有 102 名年龄≥55 岁的 AML 患者。3 年的总生存率（OS）和无复发生存率（RFS）分别为 39%和 37%。OS 的多变量分析显示年龄≥60 岁、活动性（allo-SCT 前未缓解或未经治疗）或晚期（>CR1）疾病是不良预后因素。在 CR1 移植的患者中，3 年 OS 为 67%，而活动性/晚期疾病患者为 27%。RFS 的多变量分析显示活动性/晚期疾病是唯一的不良因素。在 CR1 移植的患者中，3 年 RFS 为 70%，而活动性/晚期疾病患者为 22%。共有 17%的患者患有≥2 级急性 GVHD。allo-SCT 来自配型不合的供体后，发生严重急性 GVHD 的风险增加。1 年内非复发死亡率（NRM）为 23%。NRM 的唯一危险因素是活动性/晚期疾病。总之，在 CR1 移植的老年 AML 患者中，来自相关或无关供体的 allo-SCT 可获得非常好的结果。移植时的疾病状态是移植成功的最重要预后因素。
