Division of Hematology and Oncology, UCLA Medical Center, Los Angeles, CA 90035, USA.
Bone Marrow Transplant. 2011 Sep;46(9):1219-25. doi: 10.1038/bmt.2010.289. Epub 2010 Dec 13.
The safety and efficacy of auto-SCT for lymphoma in older patients is not well established, particularly in those ≥70 years old. We performed a retrospective analysis comparing 17 auto-SCT recipients ≥70 years old with 39 recipients aged 65-69 years. Hematopoietic cell transplantation comorbidity index (HCT-CI) scores were similar in both groups. Nonrelapse mortality (NRM) was increased in patients aged 70 years and older (hazard ratio (HR) 6.04, P=0.0029), and OS was decreased (HR 1.98, P=0.082). 1-year NRM was 35% in patients aged ≥70 years vs 8% in those aged 65-69 years (P=0.017). The incidence of in-hospital falls was higher in those aged ≥70 years (29 vs 8%, P=0.047). In a secondary exploratory analysis, we found that the occurrence of in-hospital falls was strongly associated with inferior OS (HR 3.36, P=0.0023) and NRM (HR 4.60, P=0.009) among all patients of aged 65 years and older. We conclude that auto-SCT is feasible in older patients but that mortality rates appear increased in those over age of 70 years. In-hospital falls were correlated with higher mortality, and prevention of falls may improve outcomes. Susceptibility to falls may indicate underlying frailty and should be explored prospectively as a means of selecting older patients for auto-SCT.
对于年龄较大的患者（尤其是≥70 岁的患者），自体干细胞移植（auto-SCT）治疗淋巴瘤的安全性和疗效尚未得到充分证实。我们进行了一项回顾性分析，比较了 17 名≥70 岁的自体 SCT 受者和 39 名 65-69 岁的受者。两组患者的造血细胞移植合并症指数（HCT-CI）评分相似。≥70 岁患者的非复发死亡率（NRM）较高（风险比（HR）为 6.04，P=0.0029），总生存率（OS）降低（HR 为 1.98，P=0.082）。≥70 岁患者的 1 年 NRM 为 35%，而 65-69 岁患者为 8%（P=0.017）。≥70 岁患者的院内跌倒发生率较高（29%比 8%，P=0.047）。在二次探索性分析中，我们发现所有≥65 岁患者中，院内跌倒的发生与较差的 OS（HR 为 3.36，P=0.0023）和 NRM（HR 为 4.60，P=0.009）密切相关。我们的结论是，自体 SCT 对老年患者是可行的，但 70 岁以上患者的死亡率似乎更高。院内跌倒与较高的死亡率相关，预防跌倒可能改善预后。易发生跌倒可能表明存在脆弱性，应前瞻性地进行探索，作为选择老年患者进行自体 SCT 的一种手段。
