韩国 60 岁及以上老年患者异基因造血干细胞移植的临床经验。
Clinical Experience of Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients Aged 60 Years and Older in South Korea.
机构信息
Division of Hemato-Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
Division of Hematology, Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea.
出版信息
Yonsei Med J. 2023 Feb;64(2):123-132. doi: 10.3349/ymj.2022.0331.
PURPOSE
The purpose of this study is to share our outcomes and experiences on allogeneic hematopoietic stem cell transplantation (HSCT) in elderly patients aged 60 years and older with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) in South Korea, and to compare them with other studies.
MATERIALS AND METHODS
We analyzed the clinical outcomes of 116 patients with AML or MDS aged 60 years and older who underwent allogeneic HSCT. We also analyzed which pretreatment factors affect the overall survival (OS) after allogeneic HSCT.
RESULTS
Neutrophil and platelet engraftment were achieved at median day +11 [interquartile range (IQR) 10-15] and +14 (IQR 11-19), respectively. A complete donor chimerism was confirmed in 65 (56.0%) patients at 3 weeks and in 63 (54.3%) patients at 3 months after HSCT. The estimated incidence of grade II-IV acute graft-versus-host disease (GVHD) at day 100 was 13.7%. The estimated incidence of chronic GVHD at 2 years was 38.8%. Within a median follow-up of 14 months after HSCT, OS was 64% at 1 year and 55% at 2 years, and non-relapse mortality (NRM) was 20% at 1 year and 28% at 2 years. Multivariate analysis revealed that male sex and Hematopoietic Cell Transplantation-Specific Comorbidity Index ≥3 were associated with poor OS.
CONCLUSION
This study showed that allogeneic HSCT in elderly adults aged 60 and older can be performed with successful engraftment and acceptable NRM and OS are expected given the generally known survival of patients with higher risk MDS and poor risk AML.
目的
本研究旨在分享韩国年龄在 60 岁及以上、患有骨髓增生异常综合征（MDS）或急性髓系白血病（AML）的老年患者进行异基因造血干细胞移植（HSCT）的结果和经验，并与其他研究进行比较。
材料与方法
我们分析了 116 例年龄在 60 岁及以上、患有 AML 或 MDS 的患者进行异基因 HSCT 的临床结果。我们还分析了哪些预处理因素影响异基因 HSCT 后的总生存（OS）。
结果
中性粒细胞和血小板植入分别在中位数第 11 天[四分位距（IQR）10-15]和第 14 天（IQR 11-19）达到。65 例（56.0%）患者在 HSCT 后 3 周，63 例（54.3%）患者在 3 个月时确认完全供者嵌合。100 天时 II-IV 级急性移植物抗宿主病（GVHD）的估计发生率为 13.7%。2 年时慢性 GVHD 的估计发生率为 38.8%。在 HSCT 后中位随访 14 个月时，1 年 OS 为 64%，2 年 OS 为 55%，1 年非复发死亡率（NRM）为 20%，2 年 NRM 为 28%。多变量分析显示，男性和造血细胞移植特异性合并症指数（HCT-CI）≥3 与 OS 不良相关。
结论
本研究表明，年龄在 60 岁及以上的老年患者可以进行异基因 HSCT，成功植入，NRM 可接受，考虑到高危 MDS 和不良风险 AML 患者的生存率通常已知，预计 OS 良好。
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