Outcomes in Patients Age 70 or Older Undergoing Allogeneic Hematopoietic Stem Cell Transplantation for Hematologic Malignancies
Outcomes in Patients Age 70 or Older Undergoing Allogeneic Hematopoietic Stem Cell Transplantation for Hematologic Malignancies
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DOI：
10.1016/j.bbmt.2013.06.008
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发表时间：
2013-09-01
影响因子：
4.3
通讯作者：
Chen, Yi-Bin
中科院分区：
文献类型：
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作者：
Brunner, Andrew M.;Kim, Haesook T.;Chen, Yi-Bin
异基因造血干细胞移植(HSCT)可以在许多晚期血液系统恶性肿瘤患者中实现持久缓解。对70岁或以上患者进行造血干细胞移植的安全性知之甚少。连续54例年龄在70岁或以上的患者在2007至2012年间接受了HSCT。疾病包括急性髓系白血病25例，骨髓增生异常综合征12例，慢性淋巴细胞白血病5例，非霍奇金淋巴瘤4例，急性淋巴细胞白血病3例，骨髓增生性肿瘤4例，慢性粒细胞白血病1例。幸存者的中位随访期为21个月。所有患者都接受了降低强度的预适应方案，主要是丁硫丹/氟达拉滨。所有患者接受了未经处理的外周血干细胞移植：44例来自8/8匹配的无关供者，8例来自匹配的亲缘供者，2例来自7/8匹配的非亲缘供者。所有患者的移植物抗宿主病(GVHD)预防均以钙调神经磷酸酶抑制剂为基础。移植时的平均年龄为71岁(范围从70到76)；HCT共病指数的中位数得分为1(范围从0到5)。2例患者在造血恢复前死亡(1例移植失败，1例疾病进展)，1例在造血恢复前复发；否则，所有患者在1个月时植入的供者嵌合率中位数为94%。II~IV级急性移植物抗宿主病的累积发生率为13%，III~IV级急性移植物抗宿主病的累积发生率为9.3%。两年后，慢性移植物抗宿主病的累积发生率为36%，无进展存活率为39%，总存活率为39%，复发率为56%。+100d无复发死亡率为3.7%，2年为5.6%。我们的结论是，对于精心挑选的70岁或70岁以上的患者来说，异基因造血干细胞移植是一种安全有效的选择。(C)2013年美国血液和骨髓移植学会。
Allogeneic hematopoietic stem cell transplantation (HSCT) can achieve durable remissions in a number of patients with advanced hematologic malignancies. Little is known about the safety of HSCT in patients age 70 or older. Consecutive patients (n = 54) age 70 or older underwent HSCT between 2007 and 2012. Diseases included acute myelogenous leukemia (n = 25), myelodysplastic syndrome (n = 12), chronic lymphocytic leukemia (n = 5), non-Hodgkin lymphoma (n = 4), acute lymphoblastic leukemia (n = 3), myeloproliferative neoplasm (n = 4), and chronic myelogenous leukemia (n = 1). Median follow-up for survivors was 21 months. All patients received reduced-intensity conditioning regimens, primarily busulfan/fludarabine. All patients received unmanipulated peripheral blood stem cell grafts: 44 from 8/8 matched unrelated donors, 8 from matched related donors, and 2 from 7/8 matched unrelated donors. Graft-versus-host disease (GVHD) prophylaxis was calcineurin inhibitor based in all patients. The median age at transplantation was 71 years (range, 70 to 76); the median HCT comorbidity index score was 1 (range, 0 to 5). Two patients died before hematopoietic recovery (1 with graft failure and 1 with disease progression), and 1 patient relapsed before hematopoietic recovery; otherwise, all engrafted with median donor chimerism of 94% at 1 month. Cumulative incidence of grades II to IV acute GVHD was 13% and of grades III to IV acute GVHD, 9.3%. At 2 years, the cumulative incidence of chronic GVHD was 36%, progression-free survival was 39%, overall survival was 39%, and relapse was 56%. Nonrelapse mortality was 3.7% at day +100 and 5.6% at 2 years. We conclude that allogeneic HSCT is a safe and effective option for carefully selected patients age 70 or older. (C) 2013 American Society for Blood and Marrow Transplantation.