Age-Related Considerations in Allogeneic Hematopoietic Stem Cell Transplantation for Acute Leukemia: A 10-Year Retrospective Study.

Tanaz Bahri, Mojtaba Azari Alanjeq, Mohammad Vaezi, Ghasem Janbabaei Molla, Fatemeh Tajik Rostami, Maryam Barkhordar, Morteza Azari Alanjeq, Mohammad Biglari, Sahar Tavakoli Shiraji, Soroush Rad, Davoud Babakhani, Mohammadreza Rostami, Seied Asadollah Mousavi, Hosein Kamranzadeh Foumani, Ardeshir Ghavamzadeh
{"title":"Age-Related Considerations in Allogeneic Hematopoietic Stem Cell Transplantation for Acute Leukemia: A 10-Year Retrospective Study.","authors":"Tanaz Bahri, Mojtaba Azari Alanjeq, Mohammad Vaezi, Ghasem Janbabaei Molla, Fatemeh Tajik Rostami, Maryam Barkhordar, Morteza Azari Alanjeq, Mohammad Biglari, Sahar Tavakoli Shiraji, Soroush Rad, Davoud Babakhani, Mohammadreza Rostami, Seied Asadollah Mousavi, Hosein Kamranzadeh Foumani, Ardeshir Ghavamzadeh","doi":"10.18502/ijhoscr.v19i1.17825","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background:</b> Allogeneic hematopoietic stem cell transplantation (HSCT) has long been a curative intervention for acute leukemia, though outcomes in older patients remain suboptimal due to higher non-relapse mortality (NRM) and relapse rates. Innovations in conditioning regimens and supportive care have made HSCT accessible to patients over 50, but age-related disparities in outcomes persist. <b>Materials and Methods:</b> This 10-year retrospective cohort study reviewed all patients who underwent first-time allogeneic HSCT for acute leukemia. Patients were stratified by age at HSCT (≥ 50 years and < 50 years), and outcomes were assessed for overall survival (OS), disease-free survival (DFS), NRM, and relapse incidence (RI). <b>Results:</b> Of the 1199 patients, 152 were 50 years or older. Five-year OS rates were markedly lower in patients ≥ 50 years compared to younger patients (48.70% vs. 59.35%; <i>P</i>= 0.024 for AML and 23.60% vs. 41.96%; <i>P</i>= 0.025 for ALL). Moreover, older patients demonstrated significantly higher NRM rates (35.95% vs. 23.53%; <i>P</i>= 0.045 for AML and 78.14% vs. 26.76%; <i>P</i>= 0.005 for ALL) and a notably increased incidence of grade III-IV acute graft-versus-host disease (aGVHD). Interestingly, no significant differences were observed between the two age groups regarding DFS rates and RI. <b>Conclusion:</b> Older acute leukemia patients undergoing allogeneic HSCT face significant challenges, including elevated NRM and GVHD rates. While relapse rates were comparable, survival outcomes favored the younger cohort. These findings emphasize the need for age-adapted transplantation strategies, using reduced-intensity conditioning (RIC) regimens and further research to refine risk stratification and improve management approaches for older patients.</p>","PeriodicalId":94048,"journal":{"name":"International journal of hematology-oncology and stem cell research","volume":"19 1","pages":"60-68"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103825/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International journal of hematology-oncology and stem cell research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.18502/ijhoscr.v19i1.17825","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Allogeneic hematopoietic stem cell transplantation (HSCT) has long been a curative intervention for acute leukemia, though outcomes in older patients remain suboptimal due to higher non-relapse mortality (NRM) and relapse rates. Innovations in conditioning regimens and supportive care have made HSCT accessible to patients over 50, but age-related disparities in outcomes persist. Materials and Methods: This 10-year retrospective cohort study reviewed all patients who underwent first-time allogeneic HSCT for acute leukemia. Patients were stratified by age at HSCT (≥ 50 years and < 50 years), and outcomes were assessed for overall survival (OS), disease-free survival (DFS), NRM, and relapse incidence (RI). Results: Of the 1199 patients, 152 were 50 years or older. Five-year OS rates were markedly lower in patients ≥ 50 years compared to younger patients (48.70% vs. 59.35%; P= 0.024 for AML and 23.60% vs. 41.96%; P= 0.025 for ALL). Moreover, older patients demonstrated significantly higher NRM rates (35.95% vs. 23.53%; P= 0.045 for AML and 78.14% vs. 26.76%; P= 0.005 for ALL) and a notably increased incidence of grade III-IV acute graft-versus-host disease (aGVHD). Interestingly, no significant differences were observed between the two age groups regarding DFS rates and RI. Conclusion: Older acute leukemia patients undergoing allogeneic HSCT face significant challenges, including elevated NRM and GVHD rates. While relapse rates were comparable, survival outcomes favored the younger cohort. These findings emphasize the need for age-adapted transplantation strategies, using reduced-intensity conditioning (RIC) regimens and further research to refine risk stratification and improve management approaches for older patients.

同种异体造血干细胞移植治疗急性白血病的年龄相关性:一项10年回顾性研究。
背景:异基因造血干细胞移植(HSCT)长期以来一直是治疗急性白血病的一种干预手段,尽管由于较高的非复发死亡率(NRM)和复发率,老年患者的结果仍然不理想。调节方案和支持性护理方面的创新使得50岁以上的患者也可以进行HSCT,但与年龄相关的结果差异仍然存在。材料和方法:这项为期10年的回顾性队列研究回顾了所有首次接受同种异体造血干细胞移植治疗急性白血病的患者。患者按年龄(≥50岁和< 50岁)进行HSCT分层,并评估总生存期(OS)、无病生存期(DFS)、NRM和复发率(RI)。结果:1199例患者中,年龄≥50岁的有152例。≥50岁患者的5年OS率明显低于年轻患者(48.70% vs 59.35%;AML的P= 0.024,分别为23.60%和41.96%;P= 0.025)。此外,老年患者的NRM率显著高于老年患者(35.95% vs. 23.53%;AML的P= 0.045, 78.14% vs. 26.76%;急性淋巴细胞白血病(ALL)发生率P= 0.005, III-IV级急性移植物抗宿主病(aGVHD)发生率显著增加。有趣的是,在DFS率和RI方面,两个年龄组之间没有观察到显著差异。结论:接受同种异体造血干细胞移植的老年急性白血病患者面临重大挑战,包括NRM和GVHD发生率升高。虽然复发率具有可比性,但生存结果更倾向于年轻的队列。这些发现强调了适应年龄的移植策略的必要性,使用降低强度调节(RIC)方案和进一步研究来完善老年患者的风险分层和改进管理方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信