Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan.
Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan.
Transplant Cell Ther. 2024 Apr;30(4):400.e1-400.e9. doi: 10.1016/j.jtct.2024.01.068. Epub 2024 Jan 20.
There are no clear criteria for selecting elderly patients with hematologic malignancies eligible for allogeneic hematopoietic stem cell transplantation (HSCT). This study aimed to evaluate inflammatory and nutritional status biomarkers as prognostic indicators of allogeneic HSCT in elderly patients. We compared the prognostic effects of 4 representative pretransplantation biomarkers: C-reactive protein-to-albumin ratio (CAR), Glasgow Prognostic Score (GPS), prognostic nutritional index (PNI), and albumin-to-globulin ratio (AGR). A total of 143 patients age ≥60 years who underwent their first allogeneic HSCT for a hematologic malignancy were enrolled between 2010 and 2020 in our single-center cohort. The median patient age was 65 years (range, 60 to 72 years). Pretransplantation high CAR, high GPS, and low PNI scores were associated with poor overall survival (OS), but the AGR was not associated with OS. Among the 4 biomarkers, CAR stratified OS most significantly (P < .001). Multivariate analyses identified only high CAR as an independent prognostic factor associated with OS (hazard ratio [HR], 1.98; P = .031) and showed that a Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) score ≥3 also was associated with OS (HR, 2.04; P = .012). High CAR was correlated with poor performance status, male sex, and high Disease Risk Index, but not with high HCT-CI score. When the patients were stratified into 3 groups according to a composite risk assessment using CAR and HCT-CI, the 3-year OS decreased significantly with increasing scores (82.8%, 50.3%, and 27.0%, respectively; P < .0001). In conclusion, CAR is the most useful prognostic indicator among the inflammatory and nutritional status biomarkers for allogeneic HSCT in elderly patients. Inflammatory and nutritional status in the elderly may be important prognostic factors for allogeneic HSCT independent of HCT-CI score.
对于适合异体造血干细胞移植（HSCT）的老年血液病患者，目前尚无明确的选择标准。本研究旨在评估炎症和营养状态生物标志物作为老年患者异体 HSCT 的预后指标。我们比较了 4 种有代表性的移植前生物标志物：C 反应蛋白与白蛋白比值（CAR）、格拉斯哥预后评分（GPS）、预后营养指数（PNI）和白蛋白与球蛋白比值（AGR）的预后作用。2010 年至 2020 年，我们在单中心队列中纳入了 143 名年龄≥60 岁、因血液系统恶性肿瘤接受首次异体 HSCT 的患者。患者中位年龄为 65 岁（范围 60 至 72 岁）。移植前 CAR、GPS 和 PNI 评分高与总生存（OS）不良相关，但 AGR 与 OS 无关。在这 4 个标志物中，CAR 分层 OS 最显著（P<0.001）。多变量分析仅确定 CAR 为与 OS 相关的独立预后因素（危险比 [HR]，1.98；P=0.031），并且表明 HCT-CI 评分≥3 也与 OS 相关（HR，2.04；P=0.012）。CAR 与较差的表现状态、男性和高疾病风险指数相关，但与高 HCT-CI 评分无关。当根据 CAR 和 HCT-CI 进行复合风险评估将患者分为 3 组时，随着评分的增加，3 年 OS 显著降低（分别为 82.8%、50.3%和 27.0%；P<0.0001）。总之，CAR 是老年患者异体 HSCT 中最有用的预后指标。炎症和营养状态可能是独立于 HCT-CI 评分的老年患者异体 HSCT 的重要预后因素。
