Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA.
Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA.
Bone Marrow Transplant. 2017 Nov;52(11):1530-1536. doi: 10.1038/bmt.2017.182. Epub 2017 Sep 4.
Allogeneic hematopoietic stem cell transplant (AHSCT) outcomes data of older AML/myelodysplastic syndrome (MDS) patients are limited. We retrospectively evaluated consecutive patients ⩾60 years old with AML/MDS who underwent AHSCT between January 2005 and December 2014. The primary objectives were to determine nonrelapse mortality (NRM), relapse, relapse-free survival (RFS) and overall survival (OS) at 1 year post AHSCT. A total of 159 patients underwent AHSCT with a median age of 64 (range, 60-75) years. Of these, 103 patients (65%) had AML and 56 patients (35%) had MDS. At 1 year post AHSCT, grade III-IV acute GvHD and chronic GvHD occurred in 20.8% (95% confidence interval (CI), 14.9-27.5%) and 54.1% (95% CI, 46.0-61.5%) of patients, respectively. NRM, RFS, relapse rate and OS at 1 year post AHSCT were 25.3% (95% CI, 18.8-32.3%), 53.3% (95% CI, 46.1-61.7%), 21.4% (95% CI, 15.4-28.1%) and 56.4% (95% CI, 49.2-54.7%), respectively. High disease risk index was associated with poor RFS, OS and higher relapse rate (P<0.03), whereas non-thymoglobulin-based GvHD prophylaxis, higher comorbidity index (⩾3) and MDS were associated with higher NRM (P<0.03). Importantly, age did not have an adverse effect on NRM, relapse, RFS and OS. AHSCT was well tolerated. Hence, older age alone should not be considered a contraindication to AHSCT.
异基因造血干细胞移植(AHSCT)治疗老年 AML/骨髓增生异常综合征(MDS)患者的结果数据有限。我们回顾性评估了 2005 年 1 月至 2014 年 12 月期间接受 AHSCT 的年龄 ⩾60 岁的 AML/MDS 连续患者。主要目的是确定 AHSCT 后 1 年时的非复发死亡率(NRM)、复发、无复发生存(RFS)和总生存(OS)。共有 159 名患者接受了中位年龄为 64 岁(范围为 60-75 岁)的 AHSCT。其中 103 例(65%)为 AML,56 例(35%)为 MDS。AHSCT 后 1 年时,分别有 20.8%(95%置信区间(CI),14.9-27.5%)和 54.1%(95% CI,46.0-61.5%)的患者发生 3/4 级急性移植物抗宿主病(GVHD)和慢性 GVHD。AHSCT 后 1 年时的 NRM、RFS、复发率和 OS 分别为 25.3%(95% CI,18.8-32.3%)、53.3%(95% CI,46.1-61.7%)、21.4%(95% CI,15.4-28.1%)和 56.4%(95% CI,49.2-54.7%)。高疾病风险指数与较差的 RFS、OS 和较高的复发率相关(P<0.03),而非胸腺球蛋白为基础的 GVHD 预防、较高的合并症指数(⩾3)和 MDS 与较高的 NRM 相关(P<0.03)。重要的是,年龄对 NRM、复发、RFS 和 OS 没有不良影响。AHSCT 耐受性良好。因此,仅年龄较大不应被视为 AHSCT 的禁忌症。