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Age is no barrier for adults undergoing HCT for AML in CR1: contemporary CIBMTR analysis

医学 内科学 队列 移植 入射(几何) 移植物抗宿主病 髓系白血病 造血干细胞移植 年轻人 白血病 外科 肿瘤科 光学 物理
作者
Joseph Maakaron,Mei‐Jie Zhang,Karen Chen,Sunil Abhyankar,Vijaya Raj Bhatt,Saurabh Chhabra,Najla El Jurdi,Sherif Farag,Fiona He,Mark Juckett,Marcos de Lima,Navneet S. Majhail,Marjolein van der Poel,Ayman Saad,Bipin N. Savani,Celalettin Üstün,Edmund K. Waller,Mark R. Litzow,Partow Kebriaei,Christopher S. Hourigan
出处
期刊:Bone Marrow Transplantation [Springer Nature]
卷期号:57 (6): 911-917 被引量:29
标识
DOI:10.1038/s41409-022-01650-5
摘要

Acute Myeloid Leukemia (AML) has a median age at diagnosis of 67 years. The most common curative therapy remains an allogeneic hematopoietic stem cell transplantation (HCT), yet it is complicated by treatment-related mortality (TRM) and ongoing morbidity including graft versus host disease (GVHD) that may impact survival, particularly in older patients. We examined the outcomes and predictors of success in 1321 patients aged 60 years and older receiving a HCT for AML in first complete remission (CR1) from 2007-2017 and reported to the CIBMTR. Outcomes were compared in three age cohorts (60-64; 65-69; 70+). With median follow-up of nearly 3 years, patients aged 60-64 had modestly, though significantly better OS, DFS and lower TRM than those either 65-69 or 70+; cohorts with similar outcomes. Three-year OS for the 3 cohorts was 49.4%, 42.3%, and 44.7% respectively (p = 0.026). TRM was higher with increasing age, cord blood as graft source and HCT-CI score of ≥3. Conditioning intensity was not a significant predictor of OS in the 60-69 cohort with 3-year OS of 46% for RIC and 49% for MAC (p = 0.38); MAC was rarely used over age 70. There was no difference in the relapse rate, incidence of Grade III/IV acute GVHD, or moderate-severe chronic GVHD across the age cohorts. After adjusting for other predictors, age had a small effect on OS and TRM. High-risk features including poor cytogenetics and measurable residual disease (MRD) prior to HCT were each significantly associated with relapse and accounted for most of the adverse impact on OS and DFS. Age did not influence the incidence of either acute or chronic GVHD; while graft type and associated GVHD prophylaxis were most important. These data suggest that age alone is not a barrier to successful HCT for AML in CR1 and should not exclude patients from HCT. Efforts should focus on minimizing residual disease and better donor selection.
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