背景:移植后的高剂量环磷酰胺可以安全有效地使用来自单倍体亲属的同种异体移植物(兄弟姐妹,父母和子女)接受同种异体血液或骨髓移植(alloBMT)的患者。最近,二级和三级亲属也被证明是安全的同种异体移植供体.越来越多的接受alloBMT的老年患者接受了来自单倍体供体的同种异体移植物。然而,老年患者更有可能有年长的兄弟姐妹和孩子,和较大的供体年龄与较差的结果相关。
目的:在本研究中,我们报告了在接受alloBMT的患者中,孙辈作为单倍体供体的安全性和实用性,并与作为供体的儿童进行了比较.
方法:我们比较了55岁及以上、30岁以上儿童作为供体(C组;n=276)和孙辈作为供体(GC组;n=40)的alloBMT患者的特征和结局。因为许多重要的基线特征预测alloBMT后的结果,我们根据接受者年龄进行了倾向评分匹配分析,alloBMT年,疾病,移植源和造血细胞移植合并症指数(HCT-CI)。
结果:C组接受者的中位年龄为67岁(范围55-79),GC组接受者的中位年龄为73岁(范围57-78)。GC组中超过70%的接受者年龄超过70岁,与C组的27%相比。C组的供体年龄中位数为37岁(范围31-52),GC组为20岁(范围14-34)。GC组HCT-CI评分≥3的患者多于C组(32.5%vs.23%,p=0.27)。两组的两年总生存率没有差异(GC62%vs.C60%,风险比[HR]0.96,95%置信区间[CI]0.53-1.75,p=0.90),尽管来自孙辈的同种异体移植物的接受者年龄较大。C组的2年RFS为55%,GC组为50%(HR1.05,95%CI0.62-1.77,p=0.85)。非复发死亡率分布[SD](SDHR1.36,95%0.70-2.63,p=0.36),复发(SDHR0.72,95%CI0.33-1.58,p=0.42)或无复发生存率(HR1.05,95%CI0.62-1.77,p=0.85)。倾向评分匹配分析显示,2年总生存率无显著差异(GC64%vs.C53%;HR0.77,95%CI0.42-1.42,p=0.40),非复发死亡率(SDHR1.26,95%0.66-2.41,p=0.48),复发(SDHR0.57,95%CI0.21-1.52,p=0.26)或无复发生存率(HR0.94,95%CI0.57-1.54,p=0.81)。
结论:我们的结果表明,有孙子捐献者的alloBMT患者的结局与有儿童捐献者的结局相似,尽管GC组的接受者年龄较大,合并症较高。在为年龄较大的alloBMT接受者选择捐赠者时应考虑孙子。
BACKGROUND: High-dose post-transplant cyclophosphamide allows safe and effective use of allografts from
haploidentical relatives (siblings, parents and children) in patients undergoing allogeneic blood or marrow transplant (alloBMT). More recently, second- and third-degree relatives have also been shown to be safe allograft donors. An increasing number of older patients undergoing alloBMT have been receiving allografts from
haploidentical donors. However, older patients are more likely to have older siblings and children, and older donor age is associated with worse outcomes.
OBJECTIVE: In the current study, we report the safety and utility of grandchildren as
haploidentical donors and compared with children as donors in patients undergoing alloBMT.
METHODS: We compared characteristics and outcomes of alloBMT patients aged 55 years and older with children older than 30 years as donors (C group; n = 276) and those with grandchildren as donors (GC group; n = 40). Because many important baseline characteristics predict outcomes after alloBMT, we performed propensity score matched analysis based on recipient age, alloBMT year, disease, graft source and haematopoietic cell transplantation comorbidity index (HCT-CI).
RESULTS: The median age of recipients was 67 years (range 55-79) in the C group and 73 years (range 57-78) in the GC group. More than 70% of recipients in the GC group were older than 70 years, compared with 27% in the C group. The median donor age was 37 years (range 31-52) in the C group and 20 years (range 14-34) in the GC group. More patients in the GC group had HCT-CI scores ≥3 than in the C group (32.5% vs. 23%, p = 0.27). Two-year overall survival did not differ between the two groups (GC 62% vs. C 60%, hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.53-1.75, p = 0.90) despite recipients of allografts from grandchildren being older. The 2-year RFS was 55% in the C group compared with 50% in the GC group (HR 1.05, 95% CI 0.62-1.77, p = 0.85). Non-relapse mortality subdistribution [SD] (SDHR 1.36, 95% 0.70-2.63, p = 0.36), relapse (SDHR 0.72, 95% CI 0.33-1.58, p = 0.42) or relapse-free survival (HR 1.05, 95% CI 0.62-1.77, p = 0.85). Propensity score matching analysis showed no significant differences in 2-year overall survival (GC 64% vs. C 53%; HR 0.77, 95% CI 0.42-1.42, p = 0.40), non-relapse mortality (SDHR 1.26, 95% 0.66-2.41, p = 0.48), relapse (SDHR 0.57, 95% CI 0.21-1.52, p = 0.26) or relapse-free survival (HR 0.94, 95% CI 0.57-1.54, p = 0.81).
CONCLUSIONS: Our results indicate that outcomes of alloBMT patients with grandchild donors are similar to those with child donors, despite recipients\' older age and higher comorbidities in the GC group. Grandchildren should be considered when selecting a donor for older alloBMT recipients.