Outcomes of older adults undergoing allogeneic hematopoietic cell transplantation with post-transplant cyclophosphamide based prophylaxis

IF 2.3 3区 医学 Q2 HEMATOLOGY
Victoria Murillo, Paola Charry, María Suárez-Lledó, Laia Guardia, Cristina Moreno, Joan Cid, Miquel Lozano, Alexandra Pedraza, Raquel Salinas, Vanessa Vilas, Montserrat Duch, Marina Díaz-Beya, Laura Rosiñol, Jordi Esteve, Enric Carreras, Francesc Fernández-Avilés, Carmen Martínez, Montserrat Rovira, María Queralt Salas
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Abstract

This study evaluates the feasibility of using post-transplant cyclophosphamide (PTCY) prophylaxis in allo-hematopoietic cell transplantation (HCT) for adults aged 65 and older. PTCY is increasingly used to prevent graft-versus-host disease (GVHD) across all donor types, but concerns remain about potential risks, especially in older patients. Fifty-seven adults aged 65 or older with hematological malignancies, undergoing their first allo-HCT with PTCY prophylaxis between January 2011 and January 2023 were included. Overall, 94.8% of patients achieved primary engraftment. The median durations for neutrophil and platelet engraftments were 19 and 21 days. The day +30 cumulative incidence of bacterial bloodstream infection was 43.9%. No CMV reactivations occurred within the first 100 days after letermovir implementation. The day +180 cumulative incidences of grade II–IV and III–IV acute GVHD, and the 2-year cumulative incidence of moderate/severe chronic GVHD were 26.3%, 10.5%, and 4.8%. Eighteen patients (31.6%) relapsed, and 30 (52.6%) died, with relapse (16.4%) and infection (11.5%) being the main causes of death. The estimated 2-year overall survival, non-relapse mortality, cumulative incidence of relapse, and GVHD-free relapse-free survival rates were 45.5%, 27.1%, 33.9%, and 37.0%. Adults aged 70 or older had similar outcomes to those aged 65–69. This study confirms the safety and feasibility of PTCY-based allo-HCT in older adults.

接受同种异体造血细胞移植并在移植后使用环磷酰胺预防的老年人的疗效。
本研究评估了在 65 岁及以上成人异体造血细胞移植(HCT)中使用移植后环磷酰胺(PTCY)预防的可行性。PTCY越来越多地被用于预防所有供体类型的移植物抗宿主疾病(GVHD),但人们仍然担心其潜在风险,尤其是对老年患者而言。研究纳入了五十七位年龄在65岁或以上的成人血液恶性肿瘤患者,他们在2011年1月至2023年1月期间接受了首次allo-HCT,并使用了PTCY预防疗法。总体而言,94.8%的患者实现了初次移植。中性粒细胞和血小板移植的中位持续时间分别为19天和21天。第 +30 天细菌性血流感染的累计发生率为 43.9%。在使用来曲莫韦后的前 100 天内,没有发生 CMV 再激活。第+180天II-IV级和III-IV级急性GVHD累积发生率以及2年中度/重度慢性GVHD累积发生率分别为26.3%、10.5%和4.8%。18名患者(31.6%)复发,30名患者(52.6%)死亡,复发(16.4%)和感染(11.5%)是死亡的主要原因。估计的2年总生存率、非复发死亡率、复发累积发生率和无GVHD复发生存率分别为45.5%、27.1%、33.9%和37.0%。70岁或以上的成年人与65-69岁的成年人结果相似。这项研究证实了基于 PTCY 的异体肝移植在老年人中的安全性和可行性。
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来源期刊
CiteScore
5.50
自引率
0.00%
发文量
168
审稿时长
4-8 weeks
期刊介绍: European Journal of Haematology is an international journal for communication of basic and clinical research in haematology. The journal welcomes manuscripts on molecular, cellular and clinical research on diseases of the blood, vascular and lymphatic tissue, and on basic molecular and cellular research related to normal development and function of the blood, vascular and lymphatic tissue. The journal also welcomes reviews on clinical haematology and basic research, case reports, and clinical pictures.
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