Role of reduced-intensity conditioning allogeneic hematopoietic cell transplantation in older patients with de novo acute myeloid leukemia.
Role of reduced-intensity conditioning allogeneic hematopoietic cell transplantation in older patients with de novo acute myeloid leukemia.
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降低强度调理同种异体造血细胞移植在老年新发急性髓系白血病患者中的作用。
DOI：
10.1007/s00277-016-2872-y
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发表时间：
2017
期刊：
影响因子：
3.5
通讯作者：
Yano S.
中科院分区：
文献类型：
--
作者：
Yamasaki S;Hirakawa A;Aoki J;Uchida N;Fukuda T;Ogawa H;Ohashi K;Kondo T;Eto T;Kanamori H;Okumura H;Iwato K;Ichinohe T;Kanda J;Onizuka M;Kuwatsuka Y;Yanada M;Atsuta Y;Takami A;Yano S.
降低强度预处理（RIC）方案将异基因造血细胞移植（HCT）的治疗用途扩展到老年患者。通过回顾性分析2000年至2013年间的结果，评估了2325名年龄>50岁、接受首次降低强度HCT（RIC-HCT）的新发急性髓性白血病（AML）患者的生存趋势。2008-2013年期间日本RIC-HCT的年度数量（n= 205/年[1229/6年]）高于2000-2007年期间（n= 137/年[1096/8年]）。由于移植相关死亡率（TRM）的改善，2008-2013年期间的总体和无病生存率较高（P< 0.001）。AML患者的RIC-HCT生存率随着时间的推移而改善，Karnofsky体力状态（KPS）≥80的患者中RIC-HCT数量增加。然而，TRM仍然很高，复发率并没有随着时间的推移而改善。多变量分析显示，KPS ≥80和HCT完全缓解与TRM和复发较少相关，无论年龄≥65岁，生存率均较好。准确的时间和前瞻性识别TRM风险患者可能有助于制定AML患者RIC-HCT的风险适应策略，无论年龄如何。
Reduced-intensity conditioning (RIC) regimens extend the therapeutic use of allogeneic hematopoietic cell transplantation (HCT) to older patients. The survival trend in 2325 patients aged >50 years presenting with de novo acute myeloid leukemia (AML) who underwent first reduced-intensity HCT (RIC-HCT) was assessed by retrospectively analyzing outcomes between 2000 and 2013. The annual number of RIC-HCTs in Japan was higher in the 2008–2013 period (n= 205/year [1229/6 years]) than in the 2000–2007 period (n= 137/year [1096/8 years]). Overall and disease-free survival were higher in the 2008–2013 period (P< 0.001) because of the improvement in transplant-related mortality (TRM). Survival regarding RIC-HCT for AML has improved over time, with an increased number of RIC-HCTs in patients with a Karnofsky performance status (KPS) ≥80. However, TRM remains high and the relapse rate has not improved over time. Multivariate analyses showed that a KPS ≥80 and complete remission at HCT were associated with less TRM and relapse, and better survival regardless of age ≥65 years. Accurate timing and prospective identification of patients at risk of TRM may aid the development of risk-adapted strategies for RIC-HCT in AML patients regardless of age.