Comparative outcome of nonmyeloablative and myeloablative allogeneic hematopoietic cell transplantation for patients older than 50 years of age
Comparative outcome of nonmyeloablative and myeloablative allogeneic hematopoietic cell transplantation for patients older than 50 years of age
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DOI：
10.1182/blood-2004-05-1947
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发表时间：
2005-02-15
期刊：
影响因子：
20.3
通讯作者：
Soiffer, RJ
中科院分区：
文献类型：
--
作者：
Alyea, EP;Kim, HT;Soiffer, RJ
非清髓性干细胞移植（NST）越来越多地用于老年患者。从成髓细胞移植到NST对复发、移植并发症和结局的影响尚未得到充分研究。我们回顾性分析了152例年龄大于50岁的接受NST或髓母细胞移植的患者。71例患者接受非清髓性预处理，氟达拉滨（30 mg/m2/d × 4）和静脉白消安（0.8 mg/kg/d × 4）; 81例患者接受清髓性预处理，主要是环磷酰胺和全身照射。NST患者更有可能有无关供体（58%对36%; P = 0.009），既往移植（25%对4%; P = <0.0001）和移植时活动性疾病（85%对59%; P = <0.001）。尽管存在不良特征，NST组1年（51%对39%）和2年（39%对29%; P = 0.056）的总生存率有所改善。无进展生存率无差异（2年，27%对25%; P = 0.24）。2 - 4级移植物抗宿主病的发生率相似（28% vs 270%）。NST患者的非复发死亡率较低（32%对50%; P = 0.01），但复发率较高（46%对30%; P = 0.052）。我们的经验表明，在50岁以上的患者中，NST联合氟达拉滨和低剂量白消安的总体结局至少与清髓性治疗一样好。(C)2005年美国血液学会。
Nonmyeloablative stem cell transplantation (NST) is increasingly used in older patients. The impact of the shift from myeloalblative transplantation to NST on relapse, transplant complications, and outcome has yet to be fully examined. We performed a retrospective analysis of 152 patients older than 50 years undergoing NST or myeloalblative transplantation. Seventy-one patients received nonmyeloablative conditioning, fludarabine (30 mg/m(2)/d x 4) and intravenous busulfan (0.8 mg/kg/d x 4); 81 patients received myeloablative conditioning, primarily cyclophosphamide and total body irradiation. NST patients were more likely to have unrelated donors (58%, versus 36%; P =.009), a prior transplant (25% versus 4%; P = < .0001), and active disease at transplantation (85% versus 59%; P = < .001). Despite the adverse characteristics, overall survival was improved in the NST group at 1 year (51% versus 39%) and 2 years (39% versus 29%; P =.056). There was no difference in progression-free survival (2 years, 27% versus 25%; P =.24). The incidence of grade 2 to 4 graft-versus- host disease was similar (28% versus 270%). The nonrelapse mortality rate was lower for NST patients (32% versus 50%; P = .01), but the relapse rate was higher (46% versus 30%; P = .052). Our experience suggests that, in patients over age 50, NST with fludarabine and low-dose busulfan leads to an overall outcome at least as good as that following myeloablative therapy. (C) 2005 by The American Society of Hematology.