Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Department of Physical Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Transplant Cell Ther. 2023 Nov;29(11):721.e1-721.e8. doi: 10.1016/j.jtct.2023.08.023. Epub 2023 Aug 27.
Clinical research regarding the impact of pretransplantation physical function on transplantation outcomes in older adults remains limited. We retrospectively reviewed the charts of 150 consecutive patients age >55 years who underwent their first allogeneic hematopoietic cell transplantation (HCT) at our center between 2010 and 2021. We evaluated the clinical impact of pretransplantation physical function, including hand grip strength (HGS), knee extension strength (KES), and distance covered in a 6-minute walk test (6MWT), along with other clinical factors, on transplantation outcomes such as overall survival (OS), nonrelapse mortality (NRM), and cumulative incidence of disease relapse (CIR). There was no difference in OS, NRM, or CIR among the 3 age groups studied (56 to 60 years, 61 to 65 years, and 66 to 70 years). With regard to physical function tests, we divided the study patients into 2 groups based on the median HGS, KES, and 6MWT values: higher physical function and lower physical function groups. Because there were significant differences in HGS and KES between male and female patients, sex-specific threshold values were used. In a univariate analysis, OS tended to be better in the higher physical function group compared with the lower physical function group (4-year OS, 42.0% versus 32.0% in HGS, P = .14; 44.8% versus 37.8% in KES, P = .17; 46.7% versus 30.5% in 6MWT, P = .099). NRM was significantly lower in the higher physical function group (4-year NRM, 25.5% versus 39.9% in HGS, P = .045; 17.7% versus 38.0% in KES, P = .005; 22.5% versus 43.4% in 6MWT, P = .033). There was no significant difference in CIR between the higher and lower physical function groups (4-year CIR, 34.6% versus 28.7% in HGS, P = .38; 38.5% versus 25.8% in KES, P = .20; 33.0% versus 27.0% in 6MWT, P = .42). In multivariate analysis, the higher KES group (hazard ratio [HR], .54; 95% confidence interval [CI], .32 to .90) was significantly associated with better OS, as were female sex (HR, .48; 95% CI, .26 to .89) and low/intermediate Disease Risk Index (HR, 3.59; 95% CI, 2.04 to 6.31). Higher KES (HR, .37; 95% CI, .17 to .83) and female sex (HR .36; 95% CI, .13 to .998) were significantly associated with a reduced risk of NRM. Higher HGS and higher 6MWT tended to be associated with a reduced risk of NRM, but this trend was not statistically significant. Pretransplantation physical function, particularly the strength of the lower extremities, but not chronological age, is associated with NRM and OS after allogeneic HCT in adults age >55 years.
关于移植前身体功能对老年患者移植结局影响的临床研究仍然有限。我们回顾性分析了 2010 年至 2021 年在我们中心接受首次异基因造血细胞移植（HCT）的 150 例年龄 >55 岁的连续患者的病历。我们评估了移植前身体功能（包括握力、膝关节伸展力量和 6 分钟步行试验距离）的临床影响，以及其他临床因素对总生存率（OS）、非复发死亡率（NRM）和疾病复发累积发生率（CIR）的影响。在研究的 3 个年龄组（56 至 60 岁、61 至 65 岁和 66 至 70 岁）之间，OS、NRM 或 CIR 没有差异。关于身体功能测试，我们根据 HGS、KES 和 6MWT 的中位数将研究患者分为 2 组：较高的身体功能组和较低的身体功能组。由于男女患者的 HGS 和 KES 存在显著差异，因此使用了性别特异性阈值。在单变量分析中，与较低的身体功能组相比，较高的身体功能组的 OS 倾向于更好（4 年 OS，HGS 为 42.0%比 32.0%，P =.14；KES 为 44.8%比 37.8%，P =.17；6MWT 为 46.7%比 30.5%，P =.099）。NRM 在较高的身体功能组中显著降低（4 年 NRM，HGS 为 25.5%比 39.9%，P =.045；KES 为 17.7%比 38.0%，P =.005；6MWT 为 22.5%比 43.4%，P =.033）。较高和较低的身体功能组之间的 CIR 没有显著差异（4 年 CIR，HGS 为 34.6%比 28.7%，P =.38；KES 为 38.5%比 25.8%，P =.20；6MWT 为 33.0%比 27.0%，P =.42）。在多变量分析中，较高的 KES 组（危险比[HR]，.54；95%置信区间[CI]，.32 至.90）与更好的 OS 显著相关，女性（HR，.48；95% CI，.26 至.89）和低/中疾病风险指数（HR，3.59；95% CI，2.04 至 6.31）也是如此。较高的 KES（HR，.37；95% CI，.17 至.83）和女性（HR，.36；95% CI，.13 至.998）与 NRM 风险降低显著相关。较高的 HGS 和较高的 6MWT 倾向于与 NRM 风险降低相关，但这种趋势没有统计学意义。移植前的身体功能，特别是下肢的力量，但不是年龄，与 >55 岁成年人接受异基因 HCT 后的 NRM 和 OS 相关。
