Divisions of Hematology/Oncology & Infectious Diseases, BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Transplant Cell Ther. 2023 Sep;29(9):578.e1-578.e9. doi: 10.1016/j.jtct.2023.06.020. Epub 2023 Jul 3.
Allogeneic hematopoietic cell transplantation (alloHCT) provides cure for older patients with acute myeloid leukemia (AML); however, disease relapse remains a major concern. Based on recent data suggesting that younger donor age confers the greatest benefit for alloHCT with matched unrelated donors (MUDs), we attempted to answer a practical question: which donor type provides the best outcomes when an older patient with AML has a matched sibling donor (MSD, also older) versus the best MUD? This retrospective cohort registry study accessed data from the Center for International Blood and Marrow Transplant Research (CIBMTR) in patients with AML age ≥ 50 years undergoing alloHCT from older MSDs (age ≥ 50 years) or younger MUDs (age ≤ 35 years) between 2011 and 2018. The study included common allograft types, conditioning regimens, and graft-versus-host disease (GVHD) prophylaxis. The primary outcome was relapse risk. Secondary outcomes included nonrelapse mortality (NRM), GVHD, disease-free survival (DFS), and overall survival. Among 4684 eligible patients, 1736 underwent alloHCT with an older MSD (median donor age, 60 years), and 2948 underwent alloHCT from a younger MUD (median donor age, 25 years). In multivariable analysis, compared to older MSDs, the use of younger MUDs conferred a decreased relapse risk (hazard ratio [HR], .86; P = .005) and a significantly lower adjusted 5-year cumulative incidence of relapse (35% versus 41%; P = .003), but was associated with an increased risk for chronic GVHD (HR, 1.18; 95% confidence interval [CI], 1.08 to 1.29; P = .0002) and greater NRM only in the earlier period of 2011 to 2015 (HR, 1.24; P = .016). The corresponding NRM rates were significantly lower in the more recent period of 2016 to 2018 (HR, .78; P = .017). The adjusted 5-year DFS probability was 44% (95% CI, 42% to 46%) with an alloHCT from younger MUDs compared to 41% (95% CI, 38% to 43%) with older MSDs (P = .04). In summary, for older patients with AML undergoing alloHCT, the use of younger MUDs is associated with decreased relapse risk and improved DFS compared with the use of older MSDs.
异基因造血细胞移植（alloHCT）为老年急性髓系白血病（AML）患者提供了治愈的机会；然而，疾病复发仍然是一个主要问题。基于最近的数据表明，年轻的供体年龄为使用匹配无关供体（MUD）的 alloHCT 带来最大益处，我们试图回答一个实际问题：当老年 AML 患者有匹配的同胞供体（MSD，也较老）与最佳 MUD 相比，哪种供体类型提供最佳结果？这项回顾性队列登记研究从国际血液和骨髓移植研究中心（CIBMTR）获取了数据，这些数据来自 2011 年至 2018 年间接受 alloHCT 的年龄≥50 岁的 AML 患者，供体来自年龄较大的 MSD（年龄≥50 岁）或年龄较小的 MUD（年龄≤35 岁）。该研究包括常见的同种异体移植类型、预处理方案和移植物抗宿主病（GVHD）预防措施。主要结局是复发风险。次要结局包括非复发死亡率（NRM）、GVHD、无病生存（DFS）和总生存。在 4684 名合格患者中，有 1736 名接受了年龄较大的 MSD 的 alloHCT（中位供体年龄为 60 岁），有 2948 名接受了年龄较小的 MUD 的 alloHCT（中位供体年龄为 25 岁）。在多变量分析中，与年龄较大的 MSD 相比，使用年龄较小的 MUD 可降低复发风险（危险比[HR]，.86；P=0.005），并且调整后的 5 年累积复发率显著降低（35%对 41%；P=0.003），但与慢性 GVHD 的风险增加相关（HR，1.18；95%置信区间[CI]，1.08 至 1.29；P=0.0002），并且仅在 2011 年至 2015 年的早期阶段 NRM 风险增加（HR，1.24；P=0.016）。在最近的 2016 年至 2018 年期间，相应的 NRM 率显著降低（HR，.78；P=0.017）。与使用年龄较大的 MSD 相比，使用年龄较小的 MUD 进行 alloHCT 的患者调整后的 5 年 DFS 概率为 44%（95%CI，42%至 46%），而使用年龄较大的 MSD 的患者为 41%（95%CI，38%至 43%）（P=0.04）。总之，对于接受 alloHCT 的老年 AML 患者，与使用年龄较大的 MSD 相比，使用年龄较小的 MUD 与降低复发风险和改善 DFS 相关。
