Chalandon Yves, Devillier Raynier, Boumendil Ariane, Nguyen Stephanie, Bulabois Claude-Eric, Ceballos Patrice, Brissot Eolia, Rubio Marie-Thérèse, Labussière-Wallet Hélène, Maertens Johan, Chevallier Patrice, Maillard Natacha, Poiré Xavier, Castilla-Llorente Cristina, Beguin Yves, Cornillon Jérôme, Maury Sébastien, Marchand Tony, Daguindau Etienne, Bay Jacques-Olivier, Turlure Pascal, Joris Magalie, Menard Anne-Lise, Bilger Karin, Guillerm Gaelle, François Sylvie, Bazarbachi Ali, Chantepie Sylvain, Lewalle Philippe, Marçais Ambroise, Loschi Michael, Benakli Malek, Chauvet Paul, Forcade Edouard, Huynh Anne, Robin Marie, Masouridi-Levrat Stavroula
University Hospital Geneva, Hematology Service and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Institut Paoli-Calmettes, Marseille, France.
Am J Hematol. 2025 Jul;100(7):1173-1184. doi: 10.1002/ajh.27701. Epub 2025 May 6.
There are very limited data regarding the outcomes of elderly patients with acute lymphoblastic leukemia (ALL) who undergo allogeneic hematopoietic stem cell transplantation (alloHSCT). A total of 316 ALL patients aged ≥ 60 years who underwent alloHSCT between 2010 to 2022 were identified in the SFGM-TC registry. The primary objective was to evaluate progression-free survival (PFS), non-relapse mortality (NRM), relapse incidence (RI), and graft-versus-host disease (GvHD)-free relapse-free survival (GRFS), as well as their risk factors. The median age was 63.8 years (range 60-75.8), 49.8% of patients had Philadelphia-positive B-ALL (Ph + ALL), and 70.9% were in first complete remission (CR1) at transplantation. The donor was an unrelated donor in 52.1%, a matched related donor (MRD) in 26.3%, and a haplo-identical donor in 17.7%. Reduced-intensity conditioning (RIC) was administered to 64.6% of patients, while total body irradiation (TBI) was used in 35.8%. The 3-year overall survival (OS) was 46% (95% CI 40%-53%). The 3-year PFS, NRM, RI, and GRFS were 41% (95% CI 35%-48%), 23% (95% CI 18%-28%), 36% (95% CI 31%-42%), and 30% (95% CI 25%-37%), respectively. Multivariable analyses confirmed poorer OS and PFS in patients with advanced disease, with an HR of 1.79 (95% CI 1.22-2.64), p = 0.0032. Additionally, the ALL subtype significantly impacted outcomes, with an HR of 1.99 (95% CI 1.42-2.79) for non-Ph + ALL. This study suggests that alloHSCT is a viable option for elderly ALL patients, as age itself did not impact outcomes. However, advanced disease and non-Ph + ALL were associated with significantly worse survival.
关于接受异基因造血干细胞移植（alloHSCT）的老年急性淋巴细胞白血病（ALL）患者的治疗结果，相关数据非常有限。在SFGM-TC登记处中，共确定了316例年龄≥60岁且在2010年至2022年间接受alloHSCT的ALL患者。主要目的是评估无进展生存期（PFS）、非复发死亡率（NRM）、复发率（RI）和无移植物抗宿主病（GvHD）的无复发生存期（GRFS）及其危险因素。中位年龄为63.8岁（范围60 - 75.8岁），49.8%的患者为费城染色体阳性B-ALL（Ph+ALL），70.9%的患者在移植时处于首次完全缓解期（CR1）。供者为无关供者的占52.1%，匹配的相关供者（MRD）占26.3%，单倍体相合供者占17.7%。64.6%的患者接受了减低强度预处理（RIC），35.8%的患者使用了全身照射（TBI）。3年总生存期（OS）为46%（95%CI 40% - 53%）。3年PFS、NRM、RI和GRFS分别为41%（95%CI 35% - 48%）、23%（95%CI 18% - 28%）、36%（95%CI 31% - 42%）和30%（95%CI 25% - 37%）。多变量分析证实，疾病晚期患者的OS和PFS较差，风险比（HR）为1.79（95%CI 1.22 - 2.64），p = 0.0032。此外，ALL亚型对治疗结果有显著影响，非Ph+ALL的HR为1.99（95%CI 1.42 - 2.79）。这项研究表明，alloHSCT对于老年ALL患者是一个可行的选择，因为年龄本身并未影响治疗结果。然而，疾病晚期和非Ph+ALL与显著更差的生存率相关。
