Effect of Age on Outcome of Reduced-Intensity Hematopoietic Cell Transplantation for Older Patients With Acute Myeloid Leukemia in First Complete Remission or With Myelodysplastic Syndrome
Effect of Age on Outcome of Reduced-Intensity Hematopoietic Cell Transplantation for Older Patients With Acute Myeloid Leukemia in First Complete Remission or With Myelodysplastic Syndrome
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DOI：
10.1200/jco.2009.25.4821
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发表时间：
2010-04-10
影响因子：
45.3
通讯作者：
Giralt, Sergio
中科院分区：
文献类型：
--
作者：
McClune, Brian L.;Weisdorf, Daniel J.;Giralt, Sergio
目的急性髓系白血病(AML)和骨髓增生异常综合征(MDS)主要发病于老年人。由于担心过度的发病率和死亡率，通常不提供造血细胞移植(HCT)。降低强度调节(RIC)方案允许老年患者更多地使用同种异体红细胞移植。为了确定影响40岁以上首次完全缓解(MDS)AML患者RIC方案长期疗效的预后因素，并确定年龄的影响，我们分析了来自国际血液和骨髓移植研究中心(CIBMTR)的数据。患者和方法我们回顾了1995年至2005年向CIBMTR报告的1080名接受RIC HCT的患者的数据。分析结果包括中性粒细胞恢复、急性或慢性移植物抗宿主病(GVHD)发生率、无复发死亡率(NRM)、复发、无病生存率(DFS)和总生存率(OS)。结果单因素分析显示NRM、2~4级急性GVHD、慢性GVHD和复发的年龄差异无统计学意义。年龄40~54岁、55~59岁、60岁、65岁的AML患者2年生存率分别为44%(95%CI，37%~52%)、50%(95%CI，41%~59%)、34%(95%CI，25%~43%)和36%(95%CI，24%~49%)(P=0.06)；MDS患者分别为42%(95%氯，35%~49%)、35%(95%氯，27%~43%)、45%(95%氯，36%~54%)和38%(95%氯，25%~51%)(P=0.37)。多变量分析显示，年龄对NRM、复发、DFS或OS(均为P>；3)没有显著影响。更大的人类白细胞抗原差异对2年NRM、DFS和OS有不利影响。不良的细胞遗传学对复发、DFS和OS有不利影响。更好的HCT前表现状态预示着2年OS的改善。结论根据在老年患者中观察到的类似结果，我们得出结论，仅凭老年不应被认为是HCT的禁忌症。
Purpose Acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) primarily afflict older individuals. Hematopoietic cell transplantation (HCT) is generally not offered because of concerns of excess morbidity and mortality. Reduced-intensity conditioning (RIC) regimens allow increased use of allogeneic HCT for older patients. To define prognostic factors impacting long-term outcomes of RIC regimens in patients older than age 40 years with AML in first complete remission or MDS and to determine the impact of age, we analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR).Patients and Methods We reviewed data reported to the CIBMTR (1995 to 2005) on 1,080 patients undergoing RIC HCT. Outcomes analyzed included neutrophil recovery, incidence of acute or chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), relapse, disease-free survival (DFS), and overall survival (OS).Results Univariate analyses demonstrated no age group differences in NRM, grade 2 to 4 acute GVHD, chronic GVHD, or relapse. Patients age 40 to 54, 55 to 59, 60 to 64, and >= 65 years had 2-year survival rates as follows: 44% (95% Cl, 37% to 52%), 50% (95% Cl, 41% to 59%), 34% (95% Cl, 25% to 43%), and 36% (95% Cl, 24% to 49%), respectively, for patients with AML (P = .06); and 42% (95% Cl, 35% to 49%), 35% (95% Cl, 27% to 43%), 45% (95% Cl, 36% to 54%), and 38% (95% Cl, 25% to 51%), respectively, for patients with MDS (P = .37). Multivariate analysis revealed no significant impact of age on NRM, relapse, DFS, or OS (all P>.3). Greater HLA disparity adversely affected 2-year NRM, DFS, and OS. Unfavorable cytogenetics adversely impacted relapse, DFS, and OS. Better pre-HCT performance status predicted improved 2-year OS.Conclusion With these similar outcomes observed in older patients, we conclude that older age alone should not be considered a contraindication to HCT.