老年患者接受非清髓性 HLA 半相合血液或骨髓移植并联合大剂量移植后环磷酰胺的疗效
Outcomes of Nonmyeloablative HLA-Haploidentical Blood or Marrow Transplantation With High-Dose Post-Transplantation Cyclophosphamide in Older Adults.
作者信息
Kasamon Yvette L, Bolaños-Meade Javier, Prince Gabrielle T, Tsai Hua-Ling, McCurdy Shannon R, Kanakry Jennifer A, Rosner Gary L, Brodsky Robert A, Perica Karlo, Smith B Douglas, Gladstone Douglas E, Swinnen Lode J, Showel Margaret M, Matsui William H, Huff Carol Ann, Borrello Ivan, Pratz Keith W, McDevitt Michael A, Gojo Ivana, Dezern Amy E, Shanbhag Satish, Levis Mark J, Luznik Leo, Ambinder Richard F, Fuchs Ephraim J, Jones Richard J
机构信息
All authors: Johns Hopkins University, Baltimore, MD.
出版信息
J Clin Oncol. 2015 Oct 1;33(28):3152-61. doi: 10.1200/JCO.2014.60.4777. Epub 2015 Aug 10.
PURPOSE
Recent advances in nonmyeloablative (NMA), related HLA-haploidentical blood or marrow transplantation (haplo-BMT) have expanded the donor pool. This study evaluated the effect of age on NMA haplo-BMT outcomes in patients age 50 to 75 years.
PATIENTS AND METHODS
A retrospective analysis was performed of 271 consecutive patients with hematologic malignancies, age 50 to 75 years, who received NMA, T-cell-replete haplo-BMT with high-dose post-transplantation cyclophosphamide.
RESULTS
The median age was 61 years, with 115 patients (42%) age 50 to 59, 129 (48%) age 60 to 69, and 27 (10%) age 70 to 75 years. Overall, 84% of patients had intermediate- or high-/very high-risk disease. The 6-month probabilities of grade 3 or 4 acute graft-versus-host disease (GVHD) and nonrelapse mortality (NRM) were 3% and 8%, respectively. Patients in their 50s, 60s, and 70s had 6-month NRM probabilities of 8%, 9%, and 7%, respectively (P=.20). With a median follow-up of 4 years, corresponding 3-year progression-free survival probabilities were 39%, 35%, and 33% (P=.65), and corresponding 3-year overall survival probabilities were 48%, 45%, and 44% (P=.66). Three-year progression-free survival probabilities were 40% in acute myeloid leukemia (n=65), 39% in aggressive non-Hodgkin lymphoma (n=83), and 37% in indolent or mantle-cell lymphoma (n=65). Older patient age was associated with a significantly higher risk of grade 2 to 4 acute GVHD but not grade 3 to 4 acute or chronic GVHD. No statistically significant associations were found between older age (relative to age 50 to 59 years or as a continuous variable) and NRM, relapse, or survival.
CONCLUSION
NMA haplo-BMT with post-transplantation cyclophosphamide has encouraging safety and survival outcomes in patients age 50 to 75 years. In patients otherwise fit for BMT, the results support consideration of this approach despite advanced age.
目的
非清髓性（NMA）、相关的人类白细胞抗原单倍型相合血液或骨髓移植（单倍型BMT）的最新进展扩大了供体库。本研究评估了年龄对50至75岁患者NMA单倍型BMT结局的影响。
患者与方法
对271例年龄在50至75岁、患有血液系统恶性肿瘤且接受了NMA、移植后给予高剂量环磷酰胺的T细胞充足的单倍型BMT的连续患者进行回顾性分析。
结果
中位年龄为61岁，其中115例患者（42%）年龄在50至59岁，129例（48%）年龄在60至69岁，27例（10%）年龄在70至75岁。总体而言，84%的患者患有中度或高度/非常高度风险疾病。3/4级急性移植物抗宿主病（GVHD）和非复发死亡率（NRM）的6个月概率分别为3%和8%。50多岁、60多岁和70多岁的患者6个月NRM概率分别为8%、9%和7%（P = 0.20）。中位随访4年时，相应的3年无进展生存率分别为39%、35%和33%（P = 0.65），相应的3年总生存率分别为48%、45%和44%（P = 0.66）。急性髓系白血病（n = 65）的3年无进展生存率为40%，侵袭性非霍奇金淋巴瘤（n = 83）为39%，惰性或套细胞淋巴瘤（n = 65）为37%。患者年龄较大与2至4级急性GVHD风险显著较高相关，但与3至4级急性或慢性GVHD无关。未发现年龄较大（相对于50至59岁年龄组或作为连续变量）与NRM、复发或生存之间存在统计学显著关联。
结论
移植后使用环磷酰胺的NMA单倍型BMT在50至75岁患者中具有令人鼓舞的安全性和生存结局。对于其他适合BMT的患者，尽管年龄较大，这些结果支持考虑采用这种方法。
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