Outcome of allogeneic stem cell transplantation for AML and myelodysplastic syndrome in elderly patients (≥60 years)
Outcome of allogeneic stem cell transplantation for AML and myelodysplastic syndrome in elderly patients (≥60 years)
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DOI：
10.1038/bmt.2016.156
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发表时间：
2016-11-01
影响因子：
4.8
通讯作者：
Stelljes, M.
中科院分区：
文献类型：
--
作者：
Pohlen, M.;Groth, C.;Stelljes, M.
异基因造血干细胞移植（SCT）仍然是难治性AML或高危骨髓增生异常综合征（MDS）患者的最佳治疗选择。几十年来，仅年龄被广泛用作评估同种异体SCT合格性的主要标准;然而，评估老年患者中同种异体SCT的前瞻性研究仍然有限。本回顾性分析共纳入1999年至2014年期间移植的187例AML（87%）或MDS（13%）患者（中位年龄64岁，范围60-77岁）。3年无复发生存率（RFS）和总生存率（OS）分别为32%（95%置信区间（CI）：25-39%）和35%（95% CI：27-42%）。在首次完全缓解（CR 1）时接受移植的AML患者中，总生存率为49%（95% CI：35-64%），但即使是活动性疾病患者也从移植中获益，3年OS为30%（95% CI：20-40%）。多变量分析显示疾病和患者特异性风险指数是OS和非复发死亡率（NRM）的独立预后因素。总之，我们的单中心结果表明，患者一般不应该仅仅因为年龄或疾病状态而拒绝接受异基因SCT。结合移植时疾病状态和疾病特异性风险因素以及现有合并症的特定风险模型是评估老年患者移植相关风险因素的有用工具。
Allogeneic stem cell transplantation (SCT) remains the best curative option for patients with refractory AML or with high-risk myelodysplastic syndrome (MDS). For decades, age alone had been widely used as the primary criterion to assess eligibility for allogeneic SCT; however, prospective studies to evaluate allogeneic SCT in elderly patients are still limited. A total of 187 patients (median age of 64 years, range 60-77 years) with AML (87%) or MDS (13%) transplanted between 1999 and 2014 were included in this retrospective analysis. Relapse-free survival (RFS) and overall survival (OS) at 3 years were 32% (95% confidence interval (CI): 25-39%) and 35% (95% CI: 27-42%), respectively. Overall survival was 49% (95% CI: 35-64%) in AML patients who were transplanted in first complete remission (CR1), but even patients with active disease did benefit from transplantation, showing an OS at 3 years of 30% (95% CI: 20-40%). Multivariate analysis revealed disease-and patient-specific risk indices as independent prognostic factors for OS and non-relapse mortality (NRM). In conclusion, our monocenter results indicate that patients should not be generally withheld from allogeneic SCT because of age or disease status only. Specific risk models incorporating disease status and disease-specific risk factors at the time of transplantation as well as existing comorbidities are helpful tools to assess transplantation-associated risk factors of elderly patients.