背景:患有急性髓细胞性白血病或骨髓增生异常综合征(AML/MDS)的老年患者的预后很差。然而,在这一患者群体中,最近异基因造血干细胞移植(allo-HSCT)的使用有所增加.然而,为患者选择供体类型的最佳选择仍然是未满足的需求。中国老年AML/MDS患者使用allo-HSCT的数据有限。为了更好地理解和优化老年患者供体类型的选择,特别是对于那些患有难治性或复发性疾病的人,与美国和欧洲以前的研究相比。
方法:我们的回顾性研究纳入了259名年龄超过55岁的患者,这些患者在2015年4月至2022年8月之间进行了首次allo-HSCT。这些患者根据供体类型分为三组:单倍体相关供体组(单倍体相关供体移植[HID],n=184),配对同胞供体组(配对同胞供体移植[MSD],n=39),和匹配的无关供体组(匹配的无关供体移植[MUD],n=36)。用卡方检验进行统计,对数秩和精细灰色检验。
结果:队列的中位年龄为57岁(范围:55-75),26.25%的患者超过60岁。年轻患者急性移植物抗宿主病的发生率较高(HR=1.942,P=0.035),中性粒细胞恢复较快(HR=1.387,P=0.012),在整个队列中,总生存率(HR=0.567,P=0.043)优于年龄≥60岁的患者。难治性或复发性(R/R)患者中性粒细胞植入延迟(P=0.010,HR=0.752),血小板植入延迟(P<0.001,HR=0.596),复发发生率较高(HR=2.300,P=0.013),无论供体类型如何,均低于无复发生存率(RFS)(HR=1.740,HR=0.016)。当谈到移植物抗宿主无病时,无复发生存率(GRFS),根据多变量分析,MUD优于HID(HR=0.472,P=0.026)。相比之下,我们发现MSD的GRFS水平低于HID(HR=1.621,P=0.043)。
结论:供体类型的选择没有显著影响allo-HSCT的结果。然而,当考虑移植后的生活质量时,来自年轻供体的MUD或HID可能是老年患者的最佳选择。
BACKGROUND: Elderly patients with acute myeloid leukemia or myelodysplastic syndromes (AML/
MDS) have historically had poor prognoses. However, there has been a recent increase in the use of allogenic hematopoietic stem cell transplantation (allo-HSCT) are in this patient population. Nevertheless, the optimal choice of donor type for the patients remains an unmet need. Limited data exist on the use of allo-HSCT in elderly patients with AML/
MDS from
China. To better understand and optimize the selection of donor type for the elderly patients, particularly for those with refractory or relapsed disease, in comparison with the previous studies in the US and Europe.
METHODS: Our retrospective study enrolled 259 patients aged over 55 years who underwent their first allo-HSCT between April 2015 and August 2022. These patients were divided into three groups based on donor type: haploidentical related donor group (haploidentical related donor transplantation [HID], n = 184), matched sibling donor group (matched sibling donor transplantation [MSD], n = 39), and matched unrelated donor group (matched unrelated donor transplantation [MUD], n = 36). Statistics were performed with the chi-square test, the log-rank and Fine-Gray tests.
RESULTS: The median age of the cohort was 57 years (range: 55-75) and 26.25% of patients were over 60 years old. Younger patients had a higher incidence of acute graft-versus-host disease (HR = 1.942, P = 0.035), faster neutrophil recovery (HR = 1.387, P = 0.012), and better overall survival (HR = 0.567, P = 0.043) than patients aged ≥ 60 years across the entire cohort. Patients with refractory or relapsed (R/R) diseases had delayed neutrophil engraftment (P = 0.010, HR = 0.752) and platelet engraftment (P < 0.001, HR = 0.596), higher incidence of relapses (HR = 2.300, P = 0.013), and inferior relapse-free survival (RFS) (HR = 1.740, HR = 0.016) regardless of donor type. When it came to graft-versus-host-disease-free, relapse-free survival (GRFS), MUDs turned out to be superior to HIDs (HR = 0.472, P = 0.026) according to the multivariable analysis. In contrast, we found MSDs had an inferior GRFS to HIDs in parallel (HR = 1.621, P = 0.043).
CONCLUSIONS: The choice of donor type did not significantly affect the outcomes of allo-HSCT. However, when considering the quality of post-transplant life, MUDs or HIDs from younger donors may be the optimal choice for elderly patients.