Klingemann H G, Storb R, Fefer A, Deeg H J, Appelbaum F R, Buckner C D, Cheever M A, Greenberg P D, Stewart P S, Sullivan K M
Blood. 1986 Mar;67(3):770-6.
Increasing age has been reported to be a poor prognostic factor for survival after bone marrow transplantation. We evaluated causes of death and frequency and type of complications after marrow grafting in 24 syngeneic and 39 allogeneic recipients who were 45 to 68 years old at the time of transplant. Most patients were in an advanced stage of hematologic malignancy. Among patients given syngeneic transplants, actuarial disease-free survival at 7 years is 20%. The major causes of death were relapse of leukemia and idiopathic interstitial pneumonia. Among allogeneic recipients, 9 (23%) are currently alive, and actuarial disease-free survival at 7 years is 11%. Cytomegalovirus pneumonia and septicemia were the most frequent causes of death. Patients over 50 years of age had the poorest survival rate (1/13), but many of these were transplanted in an advanced stage of their disease. However, among 12 patients transplanted while in remission or at an early stage of their disease, 5 are surviving 65 to 1,160 days after transplantation, with an actuarial survival rate of 22% at 3 years. This is in contrast to those who received their transplant in relapse: 2 out of 20 patients (10%) became long-term survivors, with a probability of survival of 15% at 3 years. The actuarial incidence of grade II through IV acute graft-v-host disease (GVHD) was 30% for allogeneic recipients 45 to 50 years of age. This was not significantly different from the incidence in younger patients. In patients 51 to 62 years of age, the actuarial incidence of acute GVHD was 79%; however, this group included three partially HLA-mismatched transplants. Ten of 15 patients surviving at least 3 months developed chronic GVHD. These results suggest that marrow transplantation is feasible and should be considered in patients over 45 years, especially if recipients are in good clinical condition and are at an early stage of their disease, such as the chronic phase of chronic myelogenous leukemia and preleukemia. For patients more than 50 years of age, allogeneic marrow grafting cannot presently be considered first-line therapy.
据报道，年龄增长是骨髓移植后生存的不良预后因素。我们评估了24例同基因和39例异基因接受者骨髓移植后的死亡原因、并发症的频率和类型，这些接受者在移植时年龄为45至68岁。大多数患者处于血液系统恶性肿瘤的晚期。在接受同基因移植的患者中，7年时的精算无病生存率为20%。主要死亡原因是白血病复发和特发性间质性肺炎。在异基因接受者中，9例（23%）目前仍存活，7年时的精算无病生存率为11%。巨细胞病毒肺炎和败血症是最常见的死亡原因。50岁以上的患者生存率最差（1/13），但其中许多患者是在疾病晚期接受移植的。然而，在12例在缓解期或疾病早期接受移植的患者中，5例在移植后65至1160天存活，3年时的精算生存率为22%。这与那些在复发时接受移植的患者形成对比：20例患者中有2例（10%）成为长期幸存者，3年时的生存概率为15%。45至50岁的异基因接受者中，II至IV级急性移植物抗宿主病（GVHD）的精算发病率为30%。这与年轻患者的发病率没有显著差异。在51至62岁的患者中，急性GVHD的精算发病率为79%；然而，该组包括3例部分HLA配型不合的移植。15例至少存活3个月的患者中有10例发生了慢性GVHD。这些结果表明，骨髓移植是可行的，45岁以上的患者应考虑进行骨髓移植，特别是如果接受者临床状况良好且处于疾病早期，如慢性粒细胞白血病的慢性期和白血病前期。对于50岁以上的患者，目前不能将异基因骨髓移植视为一线治疗方法。
