Shinohara Akihito, Shindo Michiho, Nakano Nobuaki, Sakaida Emiko, Uchida Naoyuki, Fukushima Kentaro, Nakazawa Hideyuki, Serizawa Kentaro, Kanda Yoshinobu, Kawakita Toshiro, Ikeda Takashi, Ohigashi Hiroyuki, Ito Ayumu, Wakayama Toshio, Matsuoka Ken-Ichi, Fukuda Takahiro, Tanaka Junji, Atsuta Yoshiko, Nakasone Hideki
Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Hematology, Imamura General Hospital, Kagoshima, Japan.
Eur J Haematol. 2025 May;114(5):852-863. doi: 10.1111/ejh.14374. Epub 2025 Jan 20.
Fludarabine and myeloablative busulfan (FluBu4) in allogeneic hematopoietic stem cell transplantation (HSCT) for older people have not been adequately examined. This retrospective study analyzed data from a large-scale, nationwide database in Japan. Adult patients (> 15 years old, y/o) who received their first HSCT with FluBu4 for hematological malignancies were included. They were categorized into the younger (< 60 y/o, N = 1295) and the older group (≥ 60 y/o, N = 993). The 3-year overall survival (OS) rate after HSCT was significantly worse in the older group than in the other (p < 0.01, 39.9% vs. 48.5%). The 3-year non-relapse mortality (NRM) was significantly higher in the older group than in the other (p < 0.01, 30.9% vs. 23.0%), and the 3-year cumulative incidence of relapse was comparable between them. According to the multivariate analysis, age ≥ 60 years was significantly associated with poor OS and high NRM. In a subgroup analysis of the older group, the use of additional chemotherapeutic drugs to FluBu4 was significantly associated with poor OS and high NRM. Total body irradiation was significantly associated with high NRM and 1-year incidence of sinusoidal obstruction syndrome but not with OS. Thus, FluBu4 should be used with caution in older people.
氟达拉滨和清髓性白消安（FluBu4）用于老年患者的异基因造血干细胞移植（HSCT）尚未得到充分研究。这项回顾性研究分析了来自日本一个大规模全国性数据库的数据。纳入了因血液系统恶性肿瘤首次接受FluBu4进行HSCT的成年患者（>15岁）。他们被分为较年轻组（<60岁，N = 1295）和老年组（≥60岁，N = 993）。HSCT后3年总生存率（OS）在老年组显著低于另一组（p < 0.01，39.9%对48.5%）。老年组3年非复发死亡率（NRM）显著高于另一组（p < 0.01，30.9%对23.0%），且两组间3年累积复发率相当。根据多因素分析，年龄≥60岁与较差的OS和较高的NRM显著相关。在老年组的亚组分析中，在FluBu4基础上加用其他化疗药物与较差的OS和较高的NRM显著相关。全身照射与较高的NRM和1年肝窦阻塞综合征发生率显著相关，但与OS无关。因此，FluBu4在老年患者中应谨慎使用。
