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,p= 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,p= 0.035) and OS (HR = 1.98, 95% CI: 1.03–3.84,p-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,p= 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）预防移植物抗宿主病（GVHD）的单倍体相合骨髓移植（haplo BMT）相比，采用PTCy进行GVHD预防的单倍体相合外周血干细胞移植（haplo PBSCT）能降低复发率并改善无病生存期（DFS）。然而，PTCy会导致更高的GVHD发生率。目前尚不清楚，对于老年患者（>60岁），由于对GVHD和移植相关毒性的易感性更高，haplo PBSCT的益处是否会被抵消。因此，我们试图确定接受haplo PBSCT联合PTCy的老年患者是否比年轻患者预后显著更差。方法：我们评估了在莫菲特癌症中心接受异基因haplo PBSCT联合PTCy治疗的121例血液系统恶性肿瘤成年患者，并比较了≥60岁患者（n = 55）与<60岁患者（n = 66）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）累积发生率更差（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，造血干细胞移植合并症指数（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≥60岁患者的亚组分析显示，与氟达拉滨/白消安方案相比，氟达拉滨/环磷酰胺/全身照射（Flu/Cy/TBI）方案有改善2年OS的趋势：71% 对 53%（HR = 0.47，p = 0.121）。在70岁以上患者（n = 14）中，1年NRM为8%，OS为76%。结论：鉴于年龄>60岁患者与<60岁患者具有相似的OS和DFS，haplo PBSCT联合PTCy似乎是老年患者合适的移植平台。
肿瘤(癌症)患者之家