Moukalled Nour, Ferhat Allain-Thibeault, Bazarbachi Ali, Blaise Didier, Broers Annoek E C, Castilla-Llorente Cristina, Wagner-Drouet Eva, Halkes Constantijn, Schroeder Thomas, Passweg Jakob, Yakoub-Agha Ibrahim, Dreger Peter, Kröger Nicolaus, Fanin Renato, Gabellier Ludovic, Blau Igor Wolfgang, Brissot Eolia, Nagler Arnon, Giebel Sebastian, Mohty Mohamad, Ciceri Fabio
Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
EBMT Statistical Unit, Sorbonne University, Saint-Antoine Hospital, AP-HP, INSERM UMRs 938, Paris, France.
Bone Marrow Transplant. 2025 May 28. doi: 10.1038/s41409-025-02630-1.
Allogeneic hematopoietic cell transplantation remains an important curative treatment for patients with acute lymphoblastic leukemia (ALL). Over time, significant progress in transplant and post-transplant care has allowed the delivery of transplant to older patients. We assessed changes over time in characteristics and outcomes in patients ≥60 years with ALL using a dataset from the EBMT registry. We identified 832 adult patients, with T-cell ALL (n = 143), Philadelphia chromosome positive B-cell ALL (n = 471), or Philadelphia chromosome negative B-cell ALL, transplanted 2010-2022 in first remission irrespective of the donor type. Those included 280 patients transplanted in 2010-2015, and 552 patients transplanted in 2016-2022. Patients transplanted in recent years were slightly older, more likely to have T or Ph- B-ALL and to receive a myeloablative total body irradiation conditioning. The 2-year leukemia free survival (LFS) and overall survival (OS) increased over time from 42-55% and from 51-65%, respectively. In multivariate analysis, LFS, OS, chronic and extensive chronic graft-versus-host disease rates were better in recent years (hazard ratio[HR] 0.68, 0.71, 0.66 and 0.5, respectively). These real-world data can serve as a benchmark indicating that the opportunity for transplant for the fit elderly should be considered and offered when possible.
异基因造血细胞移植仍然是急性淋巴细胞白血病（ALL）患者的一种重要的治愈性治疗方法。随着时间的推移，移植及移植后护理方面取得的重大进展使得移植手术能够应用于老年患者。我们使用欧洲血液与骨髓移植协会（EBMT）登记处的数据集评估了60岁及以上ALL患者的特征和预后随时间的变化。我们确定了832例成年患者，他们患有T细胞ALL（n = 143）、费城染色体阳性B细胞ALL（n = 471）或费城染色体阴性B细胞ALL，于2010年至2022年在首次缓解期进行了移植，无论供体类型如何。其中包括280例在2010年至2015年进行移植的患者，以及552例在2016年至2022年进行移植的患者。近年来进行移植的患者年龄稍大，更有可能患有T或Ph- B-ALL，并接受清髓性全身照射预处理。2年无白血病生存率（LFS）和总生存率（OS）随时间分别从42% - 55%和51% - 65%有所提高。在多变量分析中，近年来LFS、OS、慢性和广泛性慢性移植物抗宿主病发生率均有所改善（风险比[HR]分别为0.68、0.71、0.66和0.5）。这些真实世界的数据可作为一个基准，表明对于适合的老年患者，应考虑并尽可能提供移植机会。
