Rashidi Armin, Ebadi Maryam, Colditz Graham A, DiPersio John F
Bone Marrow Transplantation and Leukemia Program, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri.
Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland.
Biol Blood Marrow Transplant. 2016 Apr;22(4):651-657. doi: 10.1016/j.bbmt.2015.10.019. Epub 2015 Oct 31.
A large number of elderly patients with acute myeloid leukemia (AML) are not offered treatments with curative intent, such as allogeneic stem cell transplantation (SCT), because of fears of toxicity and perceived futility of intensive treatment. Therefore, the outcomes of SCT in elderly AML patients remain poorly defined. We performed a meta-analysis of all previous articles up until September 22, 2015 of SCT in AML patients >60 years. The primary endpoints were relapse-free survival (RFS) and overall survival (OS) at 6 months and at 1, 2, and 3 years. A total of 13 studies (749 patients) were included. The pooled estimates and 95% confidence intervals (CI) for RFS at 6 months, 1 year, 2 years, and 3 years were 62% (95% CI, 54% to 69%), 47% (95% CI, 42% to 53%), 44% (95% CI, 33% to 55%), and 35% (95% CI, 26% to 45%), respectively. The corresponding numbers for OS were 73% (95% CI, 66% to 79%), 58% (95% CI, 50% to 65%), 45% (95% CI, 35% to 54%), and 38% (95% CI, 29% to 48%), respectively. We found no evidence of publication bias in our primary endpoints, with the exception of relapse, where there appeared to be a relative lack of small studies with high relapse rates. Sensitivity analysis did not identify an overtly influential study for our primary endpoints, with 1 exception in 2-year RFS analysis. The present analysis argues against significant publication bias and demonstrates consistency among reports despite differences in patient-, disease-, center-, and transplantation-related characteristics. Our results suggest that reduced-intensity SCT is a viable treatment option for elderly AML patients with a 3-year RFS of 35% for those over the age of 60. These results argue against using age per se as the sole criterion against SCT and would help remove some of the barriers that often preclude curative intent treatment. Correct identification of patients who would benefit from SCT can improve outcomes in this frequently undertreated population.
由于担心毒性以及认为强化治疗徒劳无益，大量老年急性髓系白血病（AML）患者未接受具有治愈意图的治疗，如异基因干细胞移植（SCT）。因此，老年AML患者接受SCT的疗效仍不明确。我们对截至2015年9月22日之前所有关于60岁以上AML患者接受SCT的文章进行了荟萃分析。主要终点是6个月以及1、2和3年时的无复发生存期（RFS）和总生存期（OS）。共纳入13项研究（749例患者）。6个月、1年、2年和3年时RFS的合并估计值及95%置信区间（CI）分别为62%（95%CI，54%至69%）、47%（95%CI，42%至53%）、44%（95%CI，33%至55%）和35%（95%CI，26%至45%）。OS的相应数值分别为73%（95%CI，66%至79%）、58%（95%CI，50%至65%）、45%（95%CI，35%至54%）和38%（95%CI，29%至48%）。除复发外，我们在主要终点中未发现发表偏倚的证据，在复发方面，似乎相对缺乏高复发率的小型研究。敏感性分析未确定对我们主要终点有明显影响的研究，2年RFS分析中有1项例外。本分析反驳了存在显著发表偏倚的观点，并表明尽管患者、疾病、中心和移植相关特征存在差异，但各报告之间具有一致性。我们的结果表明，对于60岁以上的老年AML患者，降低强度的SCT是一种可行的治疗选择，其3年RFS为35%。这些结果反对将年龄本身作为反对SCT的唯一标准，并将有助于消除一些常常妨碍进行治愈性治疗的障碍。正确识别将从SCT中获益的患者可以改善这一经常未得到充分治疗人群的治疗效果。
