Clinical Experience of Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients Aged 60 Years and Older in South Korea
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Purpose: The purpose of this study is to share our outcomes and experiences on allogeneic hematopoietic stem cell transplanta tion (HSCT) in elderly patients aged 60 years and older with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) in South Korea, and to compare them with other studies. Materials and Methods: We analyzed the clinical outcomes of 116 patients with AML or MDS aged 60 years and older who un derwent allogeneic HSCT. We also analyzed which pretreatment factors affect the overall survival (OS) after allogeneic HSCT. Results: Neutrophil and platelet engraftment were achieved at median day +11 [interquartile range (IQR) 10–15] and +14 (IQR 11–19), respectively. A complete donor chimerism was confirmed in 65 (56.0%) patients at 3 weeks and in 63 (54.3%) patients at 3 months after HSCT. The estimated incidence of grade II–IV acute graft-versus-host disease (GVHD) at day 100 was 13.7%. The es timated incidence of chronic GVHD at 2 years was 38.8%. Within a median follow-up of 14 months after HSCT, OS was 64% at 1 year and 55% at 2 years, and non-relapse mortality (NRM) was 20% at 1 year and 28% at 2 years. Multivariate analysis revealed that male sex and Hematopoietic Cell Transplantation-Specific Comorbidity Index ≥3 were associated with poor OS. Conclusion: This study showed that allogeneic HSCT in elderly adults aged 60 and older can be performed with successful en graftment and acceptable NRM and OS are expected given the generally known survival of patients with higher risk MDS and poor risk AML.
Abstract
Purpose: The purpose of this study is to share our outcomes and experiences on allogeneic hematopoietic stem cell transplanta tion (HSCT) in elderly patients aged 60 years and older with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) in South Korea, and to compare them with other studies. Materials and Methods: We analyzed the clinical outcomes of 116 patients with AML or MDS aged 60 years and older who un derwent allogeneic HSCT. We also analyzed which pretreatment factors affect the overall survival (OS) after allogeneic HSCT. Results: Neutrophil and platelet engraftment were achieved at median day +11 [interquartile range (IQR) 10–15] and +14 (IQR 11–19), respectively. A complete donor chimerism was confirmed in 65 (56.0%) patients at 3 weeks and in 63 (54.3%) patients at 3 months after HSCT. The estimated incidence of grade II–IV acute graft-versus-host disease (GVHD) at day 100 was 13.7%. The es timated incidence of chronic GVHD at 2 years was 38.8%. Within a median follow-up of 14 months after HSCT, OS was 64% at 1 year and 55% at 2 years, and non-relapse mortality (NRM) was 20% at 1 year and 28% at 2 years. Multivariate analysis revealed that male sex and Hematopoietic Cell Transplantation-Specific Comorbidity Index ≥3 were associated with poor OS. Conclusion: This study showed that allogeneic HSCT in elderly adults aged 60 and older can be performed with successful en graftment and acceptable NRM and OS are expected given the generally known survival of patients with higher risk MDS and poor risk AML.
참고문헌 (19)
- Klepin HD, "Myelodysplastic syndromes and acute myeloid leukemia in the elderly", Clin Geriatr Med, 32, pp.155~173 (2016)
- Atilla E, "A review of myeloablative vs reduced intensity", non-myeloablative regimens in allogeneic hematopoietic stem cell transplantations, 2017, pp.34, 1~9
- Scott BL, "Myeloablative versus reduced-intensity hematopoietic cell transplantation for acute myeloid leukemia and myelodysplastic syndromes", J Clin Oncol, 35, pp.1154~1161 (2017)
- Basak GW, "Allogeneic hematopoietic cell transplantation in elderly patients aged 65 and older : a retrospective analysis by the complications and quality of life working party of the EBMT", Blood, 128, pp.681~ (2016)
- Aoki J, "Impact of age on outcomes of allogeneic hematopoietic stem cell transplantation with reduced intensity conditioning in elderly patients with acute myeloid leukemia", Am J Hematol, 91, pp.302~307 (2016)
- Greenberg PL, "Revised international prognostic scoring system for myelodysplastic syndromes", Blood, 120, pp.2454~2465 (2012)
- Döhner H, "Diagnosis and management of AML in adults : 2017ELN recommendations from an international expert panel", Blood, 129, pp.424~447 (2017)
- Rowlings PA, "IBMTR severity index for grading acute graft-versus-host disease : retrospective comparison with Glucksberg grade", Br J Haematol, 97, pp.855~864 (1997)
- Cutler C, "Peripheral blood stem cells for allogeneic transplantation : a review", Stem Cells, 19, pp.108~117 (2001)
- Eggimann L, "Kinetics of peripheral blood chimerism for surveillance of patients with leukemia and chronic myeloid malignancies after reduced-intensity conditioning allogeneic hematopoietic SCT", Bone Marrow Transplant, 50, pp.743~745 (2015)
- Koreth J, "Donor chimerism early after reduced-intensity conditioning hematopoietic stem cell transplantation predicts relapse and survival", Biol Blood Marrow Transplant, 20, pp.1516~1521 (2014)
- Luger SM, "Similar outcomes using myeloablative vs reducedintensity allogeneic transplant preparative regimens for AML or MDS", Bone Marrow Transplant, 47, pp.203~211 (2012)
- Aoudjhane M, "Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic haematopoietic stem cell transplantation for patients older than 50 years of age with acute myeloblastic leukaemia : a retrospective survey from the Acute Leukemia Working Party(ALWP)of the European group for Blood and Marrow Transplantation(EBMT)", Leukemia, 19, pp.2304~2312 (2005)
- Rashidi A, "Outcomes of allogeneic stem cell transplantation in elderly patients with acute myeloid leukemia : a systematic review and meta-analysis", Biol Blood Marrow Transplant, 22, pp.651~657 (2016)
- Pohlen M, "Outcome of allogeneic stem cell transplantation for AML and myelodysplastic syndrome in elderly patients(≥60 years)", Bone Marrow Transplant, 51, pp.1441~1448 (2016)
- Kim HT, "Donor and recipient sex in allogeneic stem cell transplantation : what really matters", Haematologica, 101, pp.1260~1266 (2016)
- Jabbour EJ, "Outcome of patients with low-risk and intermediate-1-risk myelodysplastic syndrome after hypomethylating agent failure : a report on behalf of the MDS clinical research consortium", Cancer, 121, pp.876~882 (2015)
- Lachowiez C, "Allogeneic transplantation outcomes amongst a contemporary cohort of high-risk myelodysplastic syndrome and acute myeloid leukemia patients aged ≥70 years", Hematol Oncol Stem Cell Ther, 12, pp.105~109 (2019)
- Scott BL, "Myeloablative versus reduced-intensity conditioning for hematopoietic cell transplantation in acute myelogenous leukemia and myelodysplastic syndromes—long-term follow-up of the BMT CTN 0901 clinical trial", Transplant Cell Ther, 27, pp.483~ (2021)