Muffly Lori, Pasquini Marcelo C, Martens Michael, Brazauskas Ruta, Zhu Xiaochun, Adekola Kehinde, Aljurf Mahmoud, Ballen Karen K, Bajel Ashish, Baron Frederic, Battiwalla Minoo, Beitinjaneh Amer, Cahn Jean-Yves, Carabasi Mathew, Chen Yi-Bin, Chhabra Saurabh, Ciurea Stefan, Copelan Edward, D'Souza Anita, Edwards John, Foran James, Freytes Cesar O, Fung Henry C, Gale Robert Peter, Giralt Sergio, Hashmi Shahrukh K, Hildebrandt Gerhard C, Ho Vincent, Jakubowski Ann, Lazarus Hillard, Luskin Marlise R, Martino Rodrigo, Maziarz Richard, McCarthy Philip, Nishihori Taiga, Olin Rebecca, Olsson Richard F, Pawarode Attaphol, Peres Edward, Rezvani Andrew R, Rizzieri David, Savani Bipin N, Schouten Harry C, Sabloff Mitchell, Seftel Matthew, Seo Sachiko, Sorror Mohamed L, Szer Jeff, Wirk Baldeep M, Wood William A, Artz Andrew
Division of Blood and Marrow Transplantation, Stanford University, Stanford, CA.
Center for International Blood and Marrow Transplant Research and.
Blood. 2017 Aug 31;130(9):1156-1164. doi: 10.1182/blood-2017-03-772368. Epub 2017 Jul 3.
In this study, we evaluated trends and outcomes of allogeneic hematopoietic cell transplantation (HCT) in adults ≥70 years with hematologic malignancies across the United States. Adults ≥70 years with a hematologic malignancy undergoing first allogeneic HCT in the United States between 2000 and 2013 and reported to the Center for International Blood and Marrow Transplant Research were eligible. Transplant utilization and transplant outcomes, including overall survival (OS), progression-free survival (PFS), and transplant-related mortality (TRM) were studied. One thousand one hundred and six patients ≥70 years underwent HCT across 103 transplant centers. The number and proportion of allografts performed in this population rose markedly over the past decade, accounting for 0.1% of transplants in 2000 to 3.85% (N = 298) in 2013. Acute myeloid leukemia and myelodysplastic syndromes represented the most common disease indications. Two-year OS and PFS significantly improved over time (OS: 26% [95% confidence interval (CI), 21% to 33%] in 2000-2007 to 39% [95% CI, 35% to 42%] in 2008-2013, < .001; PFS: 22% [16% to 28%] in 2000-2007 to 32% [95% CI, 29% to 36%] in 2008-2013, = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time ( = .54). Multivariable analysis of OS in the modern era of 2008-2013 revealed higher comorbidity by HCT comorbidity index ≥3 (hazard ratio [HR], 1.27; = .006), umbilical cord blood graft (HR, 1.97; = .0002), and myeloablative conditioning (HR, 1.61; = .0002) as adverse factors. Over the past decade, utilization and survival after allogeneic transplant have increased in patients ≥70 years. Select adults ≥70 years with hematologic malignancies should be considered for transplant.
在本研究中，我们评估了美国70岁及以上患有血液系统恶性肿瘤的成年人接受异基因造血细胞移植（HCT）的趋势和结果。2000年至2013年间在美国接受首次异基因HCT且向国际血液和骨髓移植研究中心报告的70岁及以上患有血液系统恶性肿瘤的成年人符合条件。研究了移植利用率和移植结果，包括总生存期（OS）、无进展生存期（PFS）和移植相关死亡率（TRM）。103个移植中心的1106名70岁及以上患者接受了HCT。在过去十年中，该人群中进行的同种异体移植数量和比例显著上升，从2000年占移植总数的0.1%增至2013年的3.85%（N = 298）。急性髓系白血病和骨髓增生异常综合征是最常见的疾病适应症。随着时间推移，两年OS和PFS显著改善（OS：2000 - 2007年为26%[95%置信区间（CI），21%至33%]，2008 - 2013年为39%[95%CI，35%至42%]，P <.001；PFS：2000 - 2007年为22%[16%至28%]，2008 - 2013年为32%[95%CI，29%至36%]，P =.003）。两年TRM在33%至35%之间，且随时间无变化（P =.54）。对2008 - 2013年现代时期OS的多变量分析显示，HCT合并症指数≥3（风险比[HR]，1.27；P =.006）、脐带血移植（HR，1.97；P =.0002）和清髓性预处理（HR，1.61；P =.0002）作为不良因素。在过去十年中，70岁及以上患者的异基因移植利用率和生存率有所提高。应考虑为部分70岁及以上患有血液系统恶性肿瘤的成年人进行移植。
