Department of Internal Medicine, NU Hospital Organization, Uddevalla, Sweden.
Bone Marrow Transplant. 2012 Mar;47(3):380-6. doi: 10.1038/bmt.2011.91. Epub 2011 May 9.
Between 1982 and 2009 a total of 92 patients with myelofibrosis (MF) in chronic phase underwent allo-SCT in nine Nordic transplant centers. Myeloablative conditioning (MAC) was given to 40 patients, and reduced intensity conditioning (RIC) was used in 52 patients. The mean age in the two groups at transplantation was 46±12 and 55±8 years, respectively (P<0.001). When adjustment for age differences was made, the survival of the patients treated with RIC was significantly better (P=0.003). Among the RIC patients, the survival was significantly (P=0.003) better for the patients with age <60 years (a 10-year survival close to 80%) than for the older patients. The type of stem cell donor did not significantly affect the survival. No significant difference was found in TRM at 100 days between the MAC- and the RIC-treated patients. The probability of survival at 5 years was 49% for the MAC-treated patients and 59% in the RIC group (P=0.125). Patients treated with RIC experienced significantly less aGVHD compared with patients treated with MAC (P<0.001). The OS at 5 years was 70, 59 and 41% for patients with Lille score 0, 1 and 2, respectively (P=0.038, when age adjustment was made). Twenty-one percent of the patients in the RIC group were given donor lymphocyte infusion because of incomplete donor chimerism, compared with none of the MAC-treated patients (P<0.002). Nine percent of the patients needed a second transplant because of graft failure, progressive disease or transformation to AML, with no significant difference between the groups. Our conclusions are (1) allo-SCT performed with RIC gives a better survival compared with MAC. (2) age over 60 years is strongly related to a worse outcome and (3) patients with higher Lille score had a shorter survival.
1982 年至 2009 年间，共有 92 名慢性期骨髓纤维化（MF）患者在北欧的 9 个移植中心接受了同种异体造血干细胞移植（allo-SCT）。40 名患者接受了清髓性预处理（MAC），52 名患者接受了强度减低预处理（RIC）。两组患者的移植时年龄分别为 46±12 岁和 55±8 岁（P<0.001）。当调整年龄差异后，RIC 治疗患者的存活率显著提高（P=0.003）。在 RIC 患者中，年龄<60 岁的患者（10 年生存率接近 80%）的存活率显著（P=0.003）优于年龄较大的患者。干细胞供者类型对存活率无显著影响。MAC 和 RIC 治疗患者在 100 天的 TRM 无显著差异。5 年生存率 MAC 组为 49%，RIC 组为 59%（P=0.125）。RIC 治疗患者与 MAC 治疗患者相比，发生急性移植物抗宿主病（GVHD）的概率显著降低（P<0.001）。Lille 评分 0、1 和 2 的患者 5 年 OS 分别为 70%、59%和 41%（P=0.038，当调整年龄后）。RIC 组中有 21%的患者因不完全供者嵌合而接受供者淋巴细胞输注，而 MAC 组中没有患者接受（P<0.002）。9%的患者因移植物衰竭、疾病进展或转化为 AML 而需要进行第二次移植，两组间无显著差异。我们的结论是：（1）RIC 进行的 allo-SCT 比 MAC 获得更好的生存结果。（2）年龄超过 60 岁与较差的预后密切相关。（3）Lille 评分较高的患者生存时间较短。
