老年弥漫性大 B 细胞淋巴瘤患者自体造血细胞移植的结果。
Outcomes of Autologous Hematopoietic Cell Transplantation in Older Patients with Diffuse Large B-Cell Lymphoma.
机构信息
MedStar Georgetown University Hospital, Stem Cell Transplant and Cellular Immunotherapy Program, Division of Hematology & Oncology, Washington, District of Columbia.
CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
出版信息
Transplant Cell Ther. 2022 Aug;28(8):487.e1-487.e7. doi: 10.1016/j.jtct.2022.05.029. Epub 2022 May 21.
Data for outcomes after autologous hematopoietic cell transplantation (auto-HCT) in diffuse large B-cell lymphoma (DLBCL) patients ≥70 years are limited. Auto-HCT is feasible in older DLBCL patients. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes of auto-HCT in DLBCL patients aged 60 to 69 years (n = 363) versus ≥70 years (n = 103) between 2008 and 2019. Non-relapse mortality (NRM), relapse/progression (REL), progression-free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models. All patients received BEAM conditioning (carmustine, etoposide, cytosine arabinoside and melphalan). On univariate analysis, in the 60 to 69 years versus ≥70 years cohorts, 100-day NRM was 3% versus 4%, 5-year REL was 47% versus 45%, 5-year PFS 40% versus 38% and 5-year OS 55% versus 41%, respectively. On multivariate analysis, patients ≥70 had no significant difference in NRM (hazard ratio [HR] 1.43, 95% confidence interval [CI] 0.85-2.39), REL (HR 1.11, 95% CI 0.79-1.56), PFS (HR 1.23, 95% CI 0.92-1.63) compared to patients 60 to 69 years. Patients ≥70 years had a higher mortality (HR 1.39, 95% CI 1.05-1.85, p=0.02), likely because of inferior post-relapse OS in this cohort (HR 1.82, 95% CI 1.27-2.61, P = .001). DLBCL was the major cause of death in both cohorts (62% versus 59%). Older patients should not be denied auto-HCT solely on the basis of chronological age.
在 70 岁以上弥漫性大 B 细胞淋巴瘤(DLBCL)患者中,自体造血细胞移植(auto-HCT)后结局的数据有限。在老年 DLBCL 患者中,auto-HCT 是可行的。利用国际血液和骨髓移植研究中心(Center for International Blood and Marrow Transplant Research)数据库,我们比较了 2008 年至 2019 年期间年龄在 60 至 69 岁(n=363)与≥70 岁(n=103)的 DLBCL 患者接受 auto-HCT 的结局。采用 Cox 比例风险模型对非复发死亡率(NRM)、复发/进展(REL)、无进展生存(PFS)和总生存(OS)进行建模。所有患者均接受 BEAM 预处理(卡莫司汀、依托泊苷、阿糖胞苷和马法兰)。单因素分析显示,在 60 至 69 岁与≥70 岁队列中,100 天 NRM 分别为 3%和 4%,5 年 REL 分别为 47%和 45%,5 年 PFS 分别为 40%和 38%,5 年 OS 分别为 55%和 41%。多因素分析显示,70 岁及以上患者的 NRM(风险比 [HR] 1.43,95%置信区间 [CI] 0.85-2.39)、REL(HR 1.11,95% CI 0.79-1.56)、PFS(HR 1.23,95% CI 0.92-1.63)与 60 至 69 岁患者相比无显著差异。70 岁及以上患者的死亡率较高(HR 1.39,95% CI 1.05-1.85,p=0.02),可能是因为该队列的复发后 OS 较差(HR 1.82,95% CI 1.27-2.61,P=0.001)。DLBCL 是两个队列的主要死亡原因(62%与 59%)。不应该仅仅基于年龄而拒绝老年患者接受 auto-HCT。