Long-Term Survival and Late Deaths After Allogeneic Hematopoietic Cell Transplantation
Long-Term Survival and Late Deaths After Allogeneic Hematopoietic Cell Transplantation
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DOI：
10.1200/jco.2010.33.7212
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发表时间：
2011-06-01
影响因子：
45.3
通讯作者：
Socie, Gerard
中科院分区：
文献类型：
--
作者：
Wingard, John R.;Majhail, Navneet S.;Socie, Gerard
目的异基因造血细胞移植（HCT）是一种有效的治疗方法，但也伴随着危及生命的并发症。大多数死亡发生在移植后的头2年内。在这份报告中，我们研究了2年生存者的长期生存率，在最大的队列研究中，10,632例患者在2004年之前接受清髓性异基因HCT治疗急性髓细胞性或淋巴细胞性白血病，骨髓增生异常综合征，淋巴瘤，结果中位随访时间为9年，3,788例患者已观察10年或以上。HCT后存活10年的概率为85%。晚期死亡的主要危险因素包括高龄和慢性移植物抗宿主病（GVHD）。对于因恶性肿瘤接受移植的患者，复发是最常见的死亡原因。晚期复发的最大危险因素是移植时的晚期疾病。非复发死亡的主要危险因素是年龄较大和GVHD。当与年龄，性别和民族相匹配的一般人群相比，晚期死亡率仍然高于预期的每种疾病，与淋巴瘤的可能例外，虽然相对风险一般随着时间的推移而消退。结论长期生存的前景是优秀的2年生存的异基因HCT。然而，预期寿命仍然低于预期。因此，在疾病过程中早期进行HCT，控制GVHD，增强免疫重建，减少毒性方案，以及预防和早期治疗晚期并发症是必要的。J Clin Oncol 29：2230-2239. (C)2011年美国临床肿瘤学会
PurposeAllogeneic hematopoietic cell transplantation (HCT) is curative but is associated with life-threatening complications. Most deaths occur within the first 2 years after transplantation. In this report, we examine long-term survival in 2-year survivors in the largest cohort ever studied.Patients and MethodsRecords of 10,632 patients worldwide reported to the Center for International Blood and Marrow Transplant Research who were alive and disease free 2 years after receiving a myeloablative allogeneic HCT before 2004 for acute myelogenous or lymphoblastic leukemia, myelodysplastic syndrome, lymphoma, or severe aplastic anemia were reviewed.ResultsMedian follow-up was 9 years, and 3,788 patients had been observed for 10 or more years. The probability of being alive 10 years after HCT was 85%. The chief risk factors for late death included older age and chronic graft-versus-host disease (GVHD). For patients who underwent transplantation for malignancy, relapse was the most common cause of death. The greatest risk factor for late relapse was advanced disease at transplantation. Principal risk factors for nonrelapse deaths were older age and GVHD. When compared with age, sex, and nationality-matched general population, late deaths remained higher than expected for each disease, with the possible exception of lymphoma, although the relative risk generally receded over time.ConclusionThe prospect for long-term survival is excellent for 2-year survivors of allogeneic HCT. However, life expectancy remains lower than expected. Performance of HCT earlier in the course of disease, control of GVHD, enhancement of immune reconstitution, less toxic regimens, and prevention and early treatment of late complications are needed. J Clin Oncol 29: 2230-2239. (C) 2011 by American Society of Clinical Oncology