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供体年龄对急性髓系白血病和骨髓增生异常综合征异基因干细胞移植结果的影响。

Influence of donor age in allogeneic stem cell transplant outcome in acute myeloid leukemia and myelodisplastic syndrome.

作者信息

Bastida J M, Cabrero M, Lopez-Godino O, Lopez-Parra M, Sanchez-Guijo F, Lopez-Corral L, Vazquez L, Caballero D, Del Cañizo C

机构信息

Hematology Department; University Hospital of Salamanca, Salamanca, Spain.

Hematology Department; University Hospital of Salamanca, Salamanca, Spain.

出版信息

Leuk Res. 2015 Aug;39(8):828-34. doi: 10.1016/j.leukres.2015.05.003. Epub 2015 May 14.

Abstract

The impact of donor age in patients with acute myeloid leukemia and myelodysplastic syndrome who underwent allogeneic hematopoietic stem cell transplant (HSCT) remains unclear. In the current study, we evaluate 179 consecutive patients who received an HSCT, from January 2000 to January 2013, in our Institution. Most of the HSCT (91%) were HLA-matched. Patient and donor median age were 51 years (18-69) and 47 years (12-75) respectively, and 81 donors (45%) were older than 50 years. The median follow-up was 38 months (range 1-138), Kaplan-Meier estimated 3-year overall survival (OS) was 63% and disease free survival (DFS) was 56%. Interestingly, patients who received an HSCT from a donor older age (>50 y) showed a poorer OS (51% vs 73%; p=0.01), as well as a higher TRM (20% vs 8%; p=0.038) and higher relapse rate (28% vs 39%; p=0.03). In a stratified subanalysis, 3-year estimated OS was significantly lower among patients undergoing an HSCT from >50 years sibling donors compared to those receiving an HSCT from <50 years unrelated donor (54% vs 72%; p<0.001). In summary, we can conclude that receiving an HSCT from a donor over 50 years old is associated with poorer outcome in patients diagnosed with MDS and AML, and this information may be incorporated into the complex process of donor selection.

摘要

供体年龄对接受异基因造血干细胞移植(HSCT)的急性髓系白血病和骨髓增生异常综合征患者的影响仍不明确。在本研究中,我们评估了2000年1月至2013年1月在我院连续接受HSCT的179例患者。大多数HSCT(91%)为HLA配型相合。患者和供体的中位年龄分别为51岁(18 - 69岁)和47岁(12 - 75岁),81名供体(45%)年龄大于50岁。中位随访时间为38个月(范围1 - 138个月),Kaplan - Meier法估计的3年总生存率(OS)为63%,无病生存率(DFS)为56%。有趣的是,接受年龄大于50岁供体HSCT的患者OS较差(51%对73%;p = 0.01),移植相关死亡率(TRM)较高(20%对8%;p = 0.038),复发率也较高(28%对39%;p = 0.03)。在分层亚分析中,与接受年龄小于50岁无关供体HSCT的患者相比,接受年龄大于50岁同胞供体HSCT的患者3年估计OS显著更低(54%对72%;p < 0.001)。总之,我们可以得出结论,对于诊断为MDS和AML的患者,接受年龄超过50岁供体的HSCT与较差的预后相关,该信息可纳入复杂的供体选择过程。

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