Späth Christian, Busemann Christoph, Krüger William H
Department of Internal Medicine C - Haematology and Oncology, Marrow Transplantation, and Palliative Care, Ernst-Moritz-Arndt-University Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Germany.
J Cancer Res Clin Oncol. 2014 Nov;140(11):1981-8. doi: 10.1007/s00432-014-1748-6. Epub 2014 Jun 26.
Allogeneic stem cell transplantation (alloSCT) has become available for elderly patients or for patients with comorbidities by introduction of reduced-intense conditioning. Comorbidity-related prognosis after alloSCT can be estimated by the hematopoietic cell transplantation comorbidity index (HCT-CI).
The charts from 85 patients who have undergone 90 alloSCTs between 1999 and 2011 were analysed. Most patients received a dose-reduced conditioning and a graft from an unrelated donor. Patients were stratified for age, HCT-CI, cGvHD versus no cGvHD, and a modified HCT-CI with a further split high-risk score.
Age over 60 years did not affect the outcome. Manifestation of cGvHD improved the prognosis significantly. An additional stratification of the high-risk group of the HCT-CI revealed that even a fraction of these patients can have considerable benefit from an alloSCT. Furthermore, this high-risk collective could be clearly discriminated into two groups with different outcomes.
The investigation confirms that age is no absolute risk factor for alloSCT and demonstrates the heterogeneity of the high-risk group of the HCT-CI. A comprehensive investigation of an additional stratification is suggested. Furthermore, the authors encourage early withdrawal of immunosuppression, even in elderly patients and patients with comorbidities to permit graft-versus-leukaemia/lymphoma, since cGvHD is associated with a significantly better prognosis.
通过引入减低强度预处理，异基因干细胞移植（alloSCT）已可用于老年患者或合并症患者。异基因造血干细胞移植后与合并症相关的预后可通过造血细胞移植合并症指数（HCT-CI）进行评估。
分析了1999年至2011年间85例接受90次异基因造血干细胞移植患者的病历。大多数患者接受了减低剂量的预处理以及来自无关供体的移植物。根据年龄、HCT-CI、是否发生慢性移植物抗宿主病（cGvHD）以及进一步细分高风险评分的改良HCT-CI对患者进行分层。
60岁以上的年龄并未影响预后。慢性移植物抗宿主病的表现显著改善了预后。对HCT-CI高风险组的进一步分层显示，即使这些患者中的一部分也可从异基因造血干细胞移植中获得相当大的益处。此外，这个高风险群体可明显分为两组，其预后不同。
该研究证实年龄并非异基因造血干细胞移植的绝对风险因素，并证明了HCT-CI高风险组的异质性。建议对进一步分层进行全面研究。此外，作者鼓励即使在老年患者和合并症患者中也尽早停用免疫抑制，以促进移植物抗白血病/淋巴瘤作用，因为慢性移植物抗宿主病与显著更好的预后相关。
