He Fiona, Cao Qing, Lazaryan Aleksandr, Brunstein Claudio, Holtan Shernan, Warlick Erica, Ustun Celalettin, McClune Brian, Arora Mukta, Rashidi Armin, Eckfeldt Craig, Weisdorf Daniel J, Bejanyan Nelli
Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Blood and Marrow Transplant Program, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Biol Blood Marrow Transplant. 2017 Sep;23(9):1485-1490. doi: 10.1016/j.bbmt.2017.05.012. Epub 2017 May 15.
The treatment of elderly patients with advanced hematological malignancies has expanded to include reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (alloHCT) as a potentially curative option. We studied the association between Disease Risk Index (DRI) and clinical outcomes of 196 elderly patients (median age, 64.8; range, 60 to 75 years) with hematological malignancies receiving RIC alloHCT (2000 to 2014). Donors were related and unrelated adults (n = 100, 51.1%) or umbilical cord blood (n = 96, 48.9%). DRI classified 12 patients (6.1%) as low risk (LR), 146 patients (74.5%) as intermediate risk (IR), and 38 patients (19.4%) as high risk (HR). Two-year overall survival (OS) was 47% (52% for LR/IR versus 29% for HR, P < .01) and 2-year disease-free survival was 39% (44% for LR/IR versus 21% for HR, P < .01). Relapse incidence was 30% (26% for LR/IR versus 44% for HR, P < .01). Treatment-related mortality was 29% at 2 years; this was similar for all DRI groups. In multiple regression analysis, HR DRI was associated with increased risk of relapse (hazard ratio, 2.07; 95% confidence interval [CI], 1.34 to 3.33; P = .02) and treatment failure (hazard ratio, 2.07; 95% CI, 1.35 to 3.18; P < .01) and decreased OS (hazard ratio, 2.11; 95% CI, 1.34 to 3.33; P < .01). In elderly patients, DRI is a significant prognostic factor for post-transplantation relapse, treatment failure, and mortality. Because of increased risk of relapse leading to poor survival in HR DRI, participation in clinical trials offering relapse prevention strategies after RIC alloHCT should be encouraged when available.
老年晚期血液系统恶性肿瘤患者的治疗已扩展至包括降低强度预处理（RIC）的异基因造血细胞移植（alloHCT），这是一种潜在的治愈性选择。我们研究了疾病风险指数（DRI）与196例接受RIC alloHCT（2000年至2014年）的老年血液系统恶性肿瘤患者（中位年龄64.8岁；范围60至75岁）临床结局之间的关联。供者为相关和无关成人（n = 100，51.1%）或脐带血（n = 96，48.9%）。DRI将12例患者（6.1%）分类为低风险（LR），146例患者（74.5%）为中风险（IR），38例患者（19.4%）为高风险（HR）。两年总生存率（OS）为47%（LR/IR为52%，HR为29%，P < 0.01），两年无病生存率为39%（LR/IR为44%，HR为21%，P < 0.01）。复发率为30%（LR/IR为26%，HR为44%，P < 0.01）。两年治疗相关死亡率为29%；所有DRI组相似。在多因素回归分析中，HR DRI与复发风险增加（风险比，2.07；95%置信区间[CI]，1.34至3.33；P = 0.02）、治疗失败（风险比，2.07；95% CI，1.35至3.18；P < 0.01）及OS降低（风险比，2.11；95% CI，1.34至3.33；P < 0.01）相关。在老年患者中，DRI是移植后复发、治疗失败及死亡的重要预后因素。由于HR DRI复发风险增加导致生存不良，如有条件，应鼓励参与提供RIC alloHCT后复发预防策略的临床试验。
