Impact of age on outcomes after bone marrow transplantation for acquired aplastic anemia using HLA-matched sibling donors
Impact of age on outcomes after bone marrow transplantation for acquired aplastic anemia using HLA-matched sibling donors
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DOI：
10.3324/haematol.2010.026682
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发表时间：
2010-12-01
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影响因子：
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通讯作者：
Marsh, Judith C. W.
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文献类型：
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作者：
Gupta, Vikas;Eapen, Mary;Marsh, Judith C. W.
人类白细胞抗原相合同胞移植是后天获得性重型再生障碍性贫血的首选治疗方法。对于老年患者，可接受的作为一线治疗的移植年龄上限有所不同。因此，目前的分析试图确定年龄或移植时年龄的不同。设计与方法我们使用Logistic和Cox回归分析研究了1307例严重再生障碍性贫血患者移植后年龄的影响，调整了其他影响预后的重要因素。年龄分组(20岁，20-40岁，40岁)采用总体生存的Martingale残差图和基于生存差异的分类。结果40岁以上的患者更有可能接受过免疫抑制治疗，表现评分较差，诊断和移植之间的间隔时间较长。中性粒细胞恢复在所有年龄组中相似，但40岁以上的患者血小板恢复的可能性低于20岁以下的患者(OR 0.45，P=0.01)，但与20-40岁的患者相比(OR 0.60，P=0.10)。与20岁以下患者的死亡风险相比，40岁以上患者(RR2.7，P<；0.0001)和20-40岁患者(RR1.69，P<；0.0001)的死亡风险更高。40岁以上患者的死亡风险也高于20~40岁患者(RR1.60，P=0.008)。表现评分差的患者以及诊断和移植之间的间隔超过3个月的患者风险也更高，这意味着在考虑这种治疗方案时，尽早转诊是合适的。
BackgroundTransplantation from an HLA-matched sibling is the treatment of choice for young patients with acquired severe aplastic anemia. For older patients, the acceptable upper age limit for transplantation as first-line treatment varies. The current analysis, therefore, sought to identify age or ages at transplantation at which survival differed.Design and MethodsWe studied the effect of patients' age, adjusting for other significant factors affecting outcomes, in 1307 patients with severe aplastic anemia after HLA-matched sibling transplantation using logistic and Cox regression analysis. Age categories (< 20 years, 20-40 years, > 40 years) were determined using Martingale residual plots for overall survival and categories based on differences in survival.ResultsPatients aged over 40 years old were more likely to have had immunosuppressive therapy, a poor performance score and a longer interval between diagnosis and transplantation. Neutrophil recovery was similar in all age groups but patients aged over 40 years had a lower likelihood of platelet recovery compared to patients aged less than 20 years (OR 0.45, P=0.01) but not compared to those aged 20-40 years (OR 0.60, P=0.10). Compared to the risk of mortality in patients aged less than 20 years, mortality risks were higher in patients over 40 years old (RR 2.70, P < 0.0001) and in those aged 20-40 years (RR 1.69, P < 0.0001). The mortality risk was also higher in patients aged over 40 years than in those 20-40 years old (RR 1.60, P=0.008).ConclusionsMortality risks increased with age. Risks were also higher in patients with a poor performance score and when the interval between diagnosis and transplantation was longer than 3 months, implying earlier referral would be appropriate when this treatment option is being considered.