Yamasaki Satoshi, Yoshimoto Goichi, Ogawa Ryosuke, Aoki Kenichi, Higuchi Masakazu, Harada Naoki, Arima Fumito, Kondo Seiji, Matubara Fujio, Takahashi Tsutomu, Uike Naokuni, Miyamoto Toshihiro, Okamura Seiichi, Akashi Koichi
Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-Ku, Fukuoka, 810-8563, Japan,
Ann Hematol. 2015 Jul;94(7):1159-65. doi: 10.1007/s00277-015-2338-7. Epub 2015 Feb 24.
The introduction of reduced-intensity conditioning (RIC) regimens has made possible allogeneic hematopoietic cell transplantation (allo-HCT) in older patients with acute myeloid leukemia (AML). However, the optimal timing of allo-HCT in these patients and its relative risks and benefits when compared with chemotherapies have not been determined. This retrospective study by the Fukuoka Blood and Marrow Transplant Group compared RIC allo-HSCT with non-transplant therapies, the choice based on donor availability, in AML patients in their first complete remission (CR1). The prognostic value of various patient characteristics and disease-specific variables were investigated in 299 patients aged ≥60 years with AML in CR1. Among the 107 patients aged 60-65 years, 54 of whom received allo-HCT and 53 of whom continued chemotherapies; allo-HCT, adverse-risk group, and hematopoietic cell transplantation-comorbidity index were significant predictors of survival outcomes. Among 192 patients aged ≥66 years deemed ineligible for allo-HCT, relapse and Karnofsky performance status after induction therapy were significant predictors of survival outcomes. Findings from this study may facilitate a new standard of care for older AML patients in CR1 who are considered candidates for allo-HCT.
减低强度预处理（RIC）方案的引入使得老年急性髓系白血病（AML）患者能够进行异基因造血细胞移植（allo-HCT）。然而，这些患者进行allo-HCT的最佳时机以及与化疗相比其相对风险和益处尚未确定。福冈血液与骨髓移植组的这项回顾性研究，将RIC allo-HSCT与非移植治疗进行了比较，治疗选择基于供体可用性，研究对象为首次完全缓解（CR1）的AML患者。对299例年龄≥60岁且处于CR1期的AML患者的各种患者特征和疾病特异性变量的预后价值进行了研究。在107例年龄在60 - 65岁的患者中，54例接受了allo-HCT，53例继续接受化疗；allo-HCT、高危组和造血细胞移植合并症指数是生存结果的重要预测因素。在192例被认为不适合进行allo-HCT的年龄≥66岁的患者中，诱导治疗后的复发和卡诺夫斯基功能状态是生存结果的重要预测因素。这项研究的结果可能有助于为CR1期且被认为是allo-HCT候选者的老年AML患者制定新的护理标准。
