Yang J, Cai Y, Jiang J L, Wan L P, Bai H T, Zhu J, Li S, Song X M, Wang C
Department of Hematology, Shanghai Jiaotong University Affiliated Shanghai General Hospital, Shanghai 200080, China.
Zhonghua Xue Ye Xue Za Zhi. 2018 Aug 14;39(8):629-633. doi: 10.3760/cma.j.issn.0253-2727.2018.08.004.
To evaluate the efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for elderly patients with advanced myeloid neoplasm. From September 2014 to September 2017, 30 consecutive hospitalized 50-plus-year-old myeloid neoplasm patients were retrospectively analyzed. At the time of transplantation, 6 patients reached complete remission and the others remained no remission after treatment. The donors were identical sibling (12), matched unrelated (6) and haploidentical family member (12), respectively. 18 patients received RIC while 12 patients received MAC conditioning regiments consisted of Busulfan, cytarabine, fludarabine or clarithromycin±TBI, respectively. Five patients died early in the conditioning stage, 24 patients successfully engrafted. The median time of neutrophil engraftment was 14(10-18) d, whereas platelet engraftment was 15(10-19) d. Six cases (25%) experienced aGVHD grades Ⅱ, 8 cases (32%) cGVHD, including moderate to severe cGVHD in 2 cases (8%). Seven, 7 and 5 cases developed CMV viremia, pneumonia and herpeszoster, respectively after transplantation, but no patients died of infections. The median follow-up time of the patients was 7(0.5-38) months. Twenty-one patients were still alive. The estimated 2 years OS and LFS were 62.5% (95% 39.2%-85.8%) and 59.2% (95% 26.9%-91.5%), respectively. Univariate analysis showed that HCT-CI was the only factor influencing OS. Allogeneic hematopoietic stem cell transplantation could improve the survival of elderly patients with myeloid neoplasm.
评估异基因造血干细胞移植(allo-HSCT)治疗老年晚期髓系肿瘤患者的疗效。回顾性分析2014年9月至2017年9月期间连续收治的30例年龄≥50岁的髓系肿瘤患者。移植时,6例患者达到完全缓解,其余患者治疗后仍未缓解。供者分别为同基因同胞(12例)、匹配的无关供者(6例)和单倍体家庭成员(12例)。18例患者接受减低剂量预处理(RIC),12例患者接受分别由白消安、阿糖胞苷、氟达拉滨或克拉霉素±全身照射(TBI)组成的清髓预处理方案(MAC)。5例患者在预处理阶段早期死亡,24例患者成功植入。中性粒细胞植入的中位时间为14(10-18)天,血小板植入为15(10-19)天。6例(25%)发生Ⅱ度急性移植物抗宿主病(aGVHD),8例(32%)发生慢性移植物抗宿主病(cGVHD),其中2例(8%)为中重度cGVHD。移植后分别有7例、7例和5例发生巨细胞病毒血症、肺炎和带状疱疹,但无患者死于感染。患者的中位随访时间为7(0.5-38)个月。21例患者仍存活。估计2年总生存率(OS)和无白血病生存率(LFS)分别为62.5%(95% 39.2%-85.8%)和59.2%(95% 26.9%-91.5%)。单因素分析显示,造血细胞移植特异性合并症指数(HCT-CI)是影响OS的唯一因素。异基因造血干细胞移植可提高老年髓系肿瘤患者的生存率。