Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2021 Dec;120(12):2144-2152. doi: 10.1016/j.jfma.2020.12.021. Epub 2021 Jan 8.
BACKGROUND/PURPOSE: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the curative therapy for acute myeloid leukemia (AML) or high-risk myelodysplastic syndrome (MDS), but advanced age with multiple comorbidities limits the eligibility for allo-HSCT. We conducted a retrospective study to investigate the comorbidities assessments and prognostic factors that predict outcomes for these patients.
Clinical data of patients older than 50 years who had received diagnoses of AML or MDS and underwent allo-HSCT were obtained. Information on patient characteristics, including age, gender, allogeneic transplant type, conditioning regimens, Charlson comorbidity index (CCI), and presence of acute graft-versus-host disease (GVHD) or chronic GVHD, were collected and analyzed.
Two hundred fifty-five elderly patients with a median age at allo-HSCT of 57 years were included. The significant prognostic factors associated with worse overall survival (OS) were CCI ≥3 (hazard ratio: 1.88) and grade III-IV acute GVHD (3.18). Similar findings were noted in the non-relapse mortality analysis. To investigate the effects of chronic GVHD on patient outcomes, OS analysis was performed for those with survival >100 days after transplantation. The results revealed CCI ≥3 (1.88) and grade III-IV acute GVHD (2.73) remained poor prognostic factors for OS, whereas mild chronic GVHD (0.43) was associated with better OS.
This cohort study suggests that CCI ≥3 predicts poor outcomes, primarily due to a higher NRM risk. Careful management of GVHD after transplantation could improve outcomes in elderly patients with AML or MDS after allo-HSCT.
背景/目的：异基因造血干细胞移植（allo-HSCT）仍然是急性髓系白血病（AML）或高危骨髓增生异常综合征（MDS）的治愈性治疗方法，但年龄较大且合并多种合并症限制了 allo-HSCT 的资格。我们进行了一项回顾性研究，以调查合并症评估和预测这些患者结局的预后因素。
获取了年龄大于 50 岁且接受 AML 或 MDS 诊断并接受 allo-HSCT 的患者的临床数据。收集并分析了患者特征的信息，包括年龄、性别、同种异体移植类型、预处理方案、Charlson 合并症指数（CCI）以及急性移植物抗宿主病（GVHD）或慢性 GVHD 的存在情况。
共纳入 255 例中位年龄为 57 岁的老年患者。与总体生存（OS）较差相关的显著预后因素是 CCI≥3（危险比：1.88）和 3/4 级急性 GVHD（3.18）。在非复发死亡率分析中也观察到了类似的发现。为了研究慢性 GVHD 对患者结局的影响，对移植后生存超过 100 天的患者进行了 OS 分析。结果表明，CCI≥3（1.88）和 3/4 级急性 GVHD（2.73）仍然是 OS 的不良预后因素，而轻度慢性 GVHD（0.43）与更好的 OS 相关。
这项队列研究表明，CCI≥3 预测结局不良，主要是因为 NRM 风险较高。移植后仔细管理 GVHD 可能会改善 allo-HSCT 后 AML 或 MDS 老年患者的结局。
