Lee Xiu Hue, Ang Chieh Hwee, Tuy Tertius Tansloan, Quek Jeffrey Kim Siang, Than Hein, Lim Francesca Lorraine Wei Inng, Goh Yeow Tee, Linn Yeh Ching, Hwang William Ying Khee, Ho Aloysius Yew Leng, Ng Lawrence Cheng Kiat
Department of Haematology Singapore General Hospital Singapore Singapore.
EJHaem. 2025 Aug 1;6(4):e70115. doi: 10.1002/jha2.70115. eCollection 2025 Aug.
Allogeneic haematopoietic stem cell transplant (alloHSCT) offers a curative option for older adults with haematological malignancies. The use of geriatric assessments has transformed the landscape of haemato-oncology care by improving risk stratification. We aim to study the prognostic value of geriatric characteristics in patients aged ≥ 60 years who underwent alloHSCT at Singapore General Hospital between 2017 and 2023. Patient data were examined retrospectively.
A total of 66 patients were included, with a median age of 65 years and 42% aged above 65. Most patients had acute leukaemia (61%), and stem cell sources included matched sibling donor (18%), matched unrelated donor (33%) and haploidentical donor (48%). Karnofsky Performance Status (KPS) was ≥ 90 in 41% of patients, and 86% had Haematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) scores of 0-2. The median Cumulative Illness Rating Scale-Geriatric (CIRS-G) score was 5. A total of 12% had renal insufficiency.At a median follow-up of 32.5 months, 2-year non-relapse mortality (NRM), progression-free survival and overall survival (OS) were 21%, 55% and 58%, respectively. On multivariate analysis, age > 65 years (HR 3.84, = 0.027) and renal insufficiency (HR 6.28, = 0.005) were associated with increased risks of NRM. Similarly, age > 65 years (HR 2.75, = 0.03) and renal insufficiency (HR 3.46, = 0.01) conferred inferior OS. KPS, HCT-CI, CIRS-G, albumin, body mass index and polypharmacy did not predict for NRM and OS.
This study supports the feasibility of alloHSCT as a treatment option for older adults with haematological malignancies. Prospective studies incorporating geriatric assessment will allow personalised transplant strategies to improve post-transplant outcomes. : The authors have confirmed clinical trial registration is not needed for this submission.
异基因造血干细胞移植（alloHSCT）为老年血液系统恶性肿瘤患者提供了一种治愈性选择。老年评估的应用通过改善风险分层改变了血液肿瘤学护理的格局。我们旨在研究2017年至2023年期间在新加坡总医院接受alloHSCT的≥60岁患者中，老年特征的预后价值。对患者数据进行了回顾性研究。
共纳入66例患者，中位年龄65岁，42%的患者年龄在65岁以上。大多数患者患有急性白血病（61%），干细胞来源包括匹配的同胞供体（18%）、匹配的无关供体（33%）和单倍体相合供体（48%）。41%的患者卡诺夫斯基功能状态（KPS）≥90，86%的患者造血细胞移植合并症指数（HCT-CI）评分为0-2。累积疾病评分量表-老年版（CIRS-G）的中位评分为5。共有12%的患者存在肾功能不全。中位随访32.5个月时，2年非复发死亡率（NRM）、无进展生存期和总生存期（OS）分别为21%、55%和58%。多因素分析显示，年龄>65岁（HR 3.84，P = 0.027）和肾功能不全（HR 6.28，P = 0.005）与NRM风险增加相关。同样，年龄>65岁（HR 2.75，P = 0.03）和肾功能不全（HR 3.46，P = 0.01）导致OS较差。KPS、HCT-CI、CIRS-G、白蛋白、体重指数和多重用药并不能预测NRM和OS。
本研究支持alloHSCT作为老年血液系统恶性肿瘤患者治疗选择的可行性。纳入老年评估的前瞻性研究将有助于制定个性化的移植策略，以改善移植后结局。：作者已确认本投稿无需进行临床试验注册。
