Beelen D W, Quabeck K, Mahmoud H K, Schaefer U W, Becher R, Schmidt C G, Bamberg M, Quast U, Grosse-Wilde H, Haralambie E
Department of Internal Medicine (Tumour Research), West German Tumour Centre, University Hospital Essen, F.R.G.
Eur J Cancer Clin Oncol. 1987 Nov;23(11):1665-71. doi: 10.1016/0277-5379(87)90447-0.
To determine the influence of advanced age on long-term survival after allogeneic bone marrow transplantation (BMT), the probability of survival and the frequency of transplantation-associated complications were analysed retrospectively in 20 patients with acute leukaemia (AL) or chronic myeloid leukaemia (CML), who were 40-49 years of age (median 44.5 years) at the time of transplant. The results of this patient group were compared to those of 32 patients aged 30-39 years (median 33.5 years) with AL or CML, who also underwent BMT during the same period of time. The overall actuarial survival of the two age groups was comparable with 44% and 41% at 5.9 and 5.6 years, respectively. Patients with standard risk criteria (i.e. HLA-genotypically identical sibling donor, 1st chronic phase of CML or 1st remission of AL) showed a higher probability of survival in both groups (62% at 5.9 years in older patients and 59% at 5.5 years in younger patients, respectively). In contrast, actuarial survival in patients who underwent BMT at an advanced stage of their disease or with marrow from a partially HLA-compatible donor was significantly inferior (P = 0.04). The cumulative incidence of acute and chronic graft-versus-host disease was low in older patients (27%), who received marrow from an HLA-identical sibling donor. The most frequent cause of death was interstitial pneumonia, occurring in seven of the older patients (35%) and in seven of the younger patients (22%). This difference, however, was not statistically significant. Our results indicate that allogenic marrow transplantation in the fifth decade of life might be associated with a tolerable risk of transplantation-related complications. This treatment modality may therefore be regarded as first-line therapy for patients in 1st remission of AL or first chronic phase of CML, who show a normal performance status. The same applies to older patients in advanced stages of disease, since the results are comparable to those achieved in the younger patient group.
为确定高龄对异基因骨髓移植（BMT）后长期生存的影响，我们对20例急性白血病（AL）或慢性粒细胞白血病（CML）患者进行了回顾性分析，这些患者在移植时年龄为40 - 49岁（中位年龄44.5岁），分析了其生存概率及移植相关并发症的发生率。将该患者组的结果与同期接受BMT的32例年龄在30 - 39岁（中位年龄33.5岁）的AL或CML患者的结果进行比较。两个年龄组的总体精算生存率具有可比性，分别在5.9年和5.6年时为44%和41%。符合标准风险标准的患者（即HLA基因型相同的同胞供者、CML的第1慢性期或AL的第1次缓解期）在两组中均显示出较高的生存概率（老年患者在5.9年时为62%，年轻患者在5.5年时为59%）。相比之下，在疾病晚期或接受部分HLA匹配供者骨髓进行BMT的患者中，精算生存率显著较低（P = 0.04）。接受HLA相同同胞供者骨髓的老年患者中，急性和慢性移植物抗宿主病的累积发生率较低（27%）。最常见的死亡原因是间质性肺炎，老年患者中有7例（35%），年轻患者中有7例（22%）。然而，这种差异无统计学意义。我们的结果表明，50岁左右进行异基因骨髓移植可能与可耐受的移植相关并发症风险相关。因此，对于处于AL第1次缓解期或CML第1慢性期且身体状况正常的患者，这种治疗方式可被视为一线治疗。对于疾病晚期的老年患者也是如此，因为其结果与年轻患者组相当。
