老年与年轻患者单倍体相合外周血干细胞移植联合移植后环磷酰胺的疗效比较
Comparison of Outcomes of Haploidentical Peripheral Blood Stem Cell Transplantation with Post-Transplant Cyclophosphamide in Older Versus Younger Patients.
作者信息
Adoncecchi Giacomo, Kumar Ambuj, Mogili Krishnakar, Faramand Rawan, Liu Hien, Khimani Farhad, Mishra Asmita, Nieder Michael, Nishihori Taiga, Hansen Doris, Jain Michael, Lazaryan Aleksandr, Perez Lia, Pidala Joseph, Locke Frederick, Anasetti Claudio, Bejanyan Nelli, Elmariah Hany
机构信息
Department of Bone Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA.
Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA.
出版信息
Cancers (Basel). 2025 Jan 19;17(2):310. doi: 10.3390/cancers17020310.
BACKGROUND
Previous studies have shown that allogeneic peripheral blood stem cell transplantation (PBSCT) from an HLA haploidentical (haplo) donor followed by graft-versus-host disease (GVHD) prophylaxis with post-transplant cyclophosphamide (PTCy) results in lower relapse rates and improved DFS when compared to haplo bone marrow transplant (BMT) with PTCy. However, PBSCT leads to higher rates of GVHD. It is unknown whether the benefits of haplo PBSCT may be nullified in older patients (>60 years) by a higher susceptibility to GVHD and transplant related toxicity. Thus, we sought to determine if older patients receiving haplo PBSCT with PTCy experience significantly worse outcomes than younger patients.
METHODS
We evaluated 121 adult patients with hematologic malignancies treated at the Moffitt Cancer Center with allogeneic haplo PBSCT followed by PTCy and compared outcomes of patients ≥60 years (n = 55) versus patients <60 years (n = 66).
RESULTS
The cumulative incidence of non-relapse mortality (NRM) from the competing risk regression analysis was worse for the older patient group (SHR = 4.05, 95% CI: 1.43-11.47, = 0.008). However, there was no significant difference between groups in graft-versus-host disease (GVHD), relapse, disease-free survival (DFS), or overall survival (OS). Instead, hematopoietic comorbidity index (HCT-CI) ≥ 3 was associated with worse DFS (HR = 1.87, 95% CI: 1.04-3.34, = 0.035) and OS (HR = 1.98, 95% CI: 1.03-3.84, -value = 0.042). Subgroup analysis of patients ≥60 years showed a trend toward improved 2-year OS with fludarabine/cyclophosphamide/total body irradiation (Flu/Cy/TBI) versus fludarabine/busulfan: 71% versus 53% (HR = 0.47, = 0.121). In patients over 70 years (n = 14), NRM was 8% and OS was 76% at 1 year.
CONCLUSION
Given similar OS and DFS between patients aged >60 years and those <60, haplo PBSCT with PTCy appears to be an appropriate transplant platform for older patients.
背景
既往研究表明，与采用移植后环磷酰胺（PTCy）的单倍体相合骨髓移植（BMT）相比，接受单倍体相合（haplo）供者的异基因外周血干细胞移植（PBSCT）并采用PTCy预防移植物抗宿主病（GVHD）可降低复发率并改善无病生存期（DFS）。然而，PBSCT会导致更高的GVHD发生率。尚不清楚单倍体相合PBSCT的益处是否会因老年患者（>60岁）对GVHD和移植相关毒性的易感性较高而被抵消。因此，我们试图确定接受单倍体相合PBSCT联合PTCy的老年患者的预后是否明显比年轻患者差。
方法
我们评估了在莫菲特癌症中心接受异基因单倍体相合PBSCT并采用PTCy治疗的121例血液系统恶性肿瘤成年患者，并比较了年龄≥60岁（n = 55）和年龄<60岁（n = 66）患者的预后。
结果
竞争风险回归分析显示，老年患者组的非复发死亡率（NRM）累积发生率更高（SHR = 4.05，95% CI：1.43 - 11.47，P = 0.008）。然而，两组在移植物抗宿主病（GVHD）、复发、无病生存期（DFS）或总生存期（OS）方面无显著差异。相反，造血合并症指数（HCT - CI）≥3与较差的DFS（HR = 1.87，95% CI：1.04 - 3.34，P = 0.035）和OS（HR = 1.98，95% CI：1.03 - 3.84，P值 = 0.042）相关。对年龄≥60岁患者的亚组分析显示，采用氟达拉滨/环磷酰胺/全身照射（Flu/Cy/TBI）方案的患者2年OS有改善趋势，与氟达拉滨/白消安方案相比：分别为71%和53%（HR = 0.47，P = 0.121）。在70岁以上患者（n = 14）中，1年时NRM为8%，OS为76%。
结论
鉴于年龄>60岁和<60岁患者的OS和DFS相似，单倍体相合PBSCT联合PTCy似乎是老年患者合适的移植平台。
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