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年龄不会对接受异基因造血干细胞移植治疗 AML 和骨髓增生异常综合征的 60 岁以上患者的结局产生不利影响。

Age does not adversely influence outcomes among patients older than 60 years who undergo allogeneic hematopoietic stem cell transplant for AML and myelodysplastic syndrome.

机构信息

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.

出版信息

Bone Marrow Transplant. 2017 Nov;52(11):1530-1536. doi: 10.1038/bmt.2017.182. Epub 2017 Sep 4.

DOI:10.1038/bmt.2017.182
PMID:28869613
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6857174/
Abstract

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.

摘要

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。

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