Kawamura Koji
Division of Hematology and Clinical Laboratory Medicine, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-0853, Japan.
Yonago Acta Med. 2025 Jul 17;68(3):169-179. doi: 10.33160/yam.2025.08.001. eCollection 2025 Aug.
Allogeneic hematopoietic stem cell transplantation (allo-HCT) has been established as a curative treatment for hematological malignancies such as acute myeloid leukemia and myelodysplastic syndrome. Patients aged ≥ 70 years have traditionally been considered ineligible for this procedure, because of concerns over high transplant-related mortality rates and difficulties managing post-transplant complications. However, recent advances in supportive care, expanded donor availability, and the development of reduced-intensity conditioning (RIC) regimens have increased the availability of allo-HCT for older patients. Notably, the number of allo-HCT procedures performed in patients aged ≥ 70 has been steadily increasing in Japan and Western countries, reflecting a re-evaluation of transplant eligibility in older patients. When assessing transplant eligibility in older patients, it is crucial to consider not only disease risk stratification and treatment response, but also comprehensive evaluations of general health status, comorbidities, cognitive function, and social backgrounds. In particular, indexes such as the Hematopoietic Cell Transplantation-Comorbidity Index and Comprehensive Geriatric Assessment have proven useful for predicting patient prognoses and non-relapse mortality. Donor selection and the intensity of the conditioning regimen used can both significantly influence transplant outcomes. RIC or non-myeloablative regimens are generally recommended for patients aged ≥ 70 years. Human leukocyte antigen-matched related or younger unrelated donors are preferred, while haploidentical donors or cord blood may be considered when matched donors are unavailable, although evidence in older patients is limited. This review provides a comprehensive overview of the current status of and challenges related to allo-HCT in patients aged ≥ 70 years. Patient eligibility, conditioning strategies, donor selection, and transplant outcomes are discussed in detail, based on the latest available evidence.
异基因造血干细胞移植（allo-HCT）已被确立为治疗急性髓系白血病和骨髓增生异常综合征等血液系统恶性肿瘤的一种治愈性疗法。传统上，年龄≥70岁的患者被认为不适合进行该手术，原因是担心移植相关死亡率高以及移植后并发症管理困难。然而，支持治疗的最新进展、供体来源的扩大以及低强度预处理（RIC）方案的发展，增加了老年患者进行allo-HCT的机会。值得注意的是，在日本和西方国家，年龄≥70岁患者进行allo-HCT手术的数量一直在稳步增加，这反映了对老年患者移植资格的重新评估。在评估老年患者的移植资格时，不仅要考虑疾病风险分层和治疗反应，还要全面评估一般健康状况、合并症、认知功能和社会背景。特别是，造血细胞移植合并症指数和综合老年评估等指标已被证明有助于预测患者的预后和非复发死亡率。供体选择和所采用预处理方案的强度都会显著影响移植结果。一般建议年龄≥70岁的患者采用RIC或非清髓性方案。人类白细胞抗原匹配的亲属供体或年轻的非亲属供体是首选，而当无法获得匹配供体时，可以考虑单倍体相合供体或脐血，尽管老年患者的相关证据有限。本综述全面概述了年龄≥70岁患者allo-HCT的现状及相关挑战。基于现有最新证据，详细讨论了患者资格、预处理策略、供体选择和移植结果。
