Prognostic Value of Geriatric Characteristics in Allogeneic Haematopoietic Stem Cell Transplant Recipients Aged Over 60 Years

IF 1.2

EJHaem Pub Date : 2025-08-01 DOI:10.1002/jha2.70115

Xiu Hue Lee, Chieh Hwee Ang, Tertius Tansloan Tuy, Jeffrey Kim Siang Quek, Hein Than, Francesca Lorraine Wei Inng Lim, Yeow Tee Goh, Yeh Ching Linn, William Ying Khee Hwang, Aloysius Yew Leng Ho, Lawrence Cheng Kiat Ng

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Abstract

Introduction

Allogeneic haematopoietic stem cell transplant (alloHSCT) offers a curative option for older adults with haematological malignancies. The use of geriatric assessments has transformed the landscape of haemato-oncology care by improving risk stratification. We aim to study the prognostic value of geriatric characteristics in patients aged ≥ 60 years who underwent alloHSCT at Singapore General Hospital between 2017 and 2023. Patient data were examined retrospectively.

Results

A total of 66 patients were included, with a median age of 65 years and 42% aged above 65. Most patients had acute leukaemia (61%), and stem cell sources included matched sibling donor (18%), matched unrelated donor (33%) and haploidentical donor (48%). Karnofsky Performance Status (KPS) was ≥ 90 in 41% of patients, and 86% had Haematopoietic Cell Transplantation-Comorbidity Index (HCT-CI) scores of 0–2. The median Cumulative Illness Rating Scale-Geriatric (CIRS-G) score was 5. A total of 12% had renal insufficiency.

At a median follow-up of 32.5 months, 2-year non-relapse mortality (NRM), progression-free survival and overall survival (OS) were 21%, 55% and 58%, respectively. On multivariate analysis, age > 65 years (HR 3.84, p = 0.027) and renal insufficiency (HR 6.28, p = 0.005) were associated with increased risks of NRM. Similarly, age > 65 years (HR 2.75, p = 0.03) and renal insufficiency (HR 3.46, p = 0.01) conferred inferior OS. KPS, HCT-CI, CIRS-G, albumin, body mass index and polypharmacy did not predict for NRM and OS.

Conclusion

This study supports the feasibility of alloHSCT as a treatment option for older adults with haematological malignancies. Prospective studies incorporating geriatric assessment will allow personalised transplant strategies to improve post-transplant outcomes.

Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission

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年龄在60岁以上的异基因造血干细胞移植受者的老年特征对预后的价值

同种异体造血干细胞移植（Allogeneic hematopoietic stem cell transplantation, alloHSCT）为老年血液恶性肿瘤患者提供了一种治疗选择。老年评估的使用通过改善风险分层改变了血液肿瘤护理的格局。我们的目标是研究2017年至2023年在新加坡总医院接受同种异体造血干细胞移植的年龄≥60岁患者的老年特征的预后价值。回顾性检查患者资料。结果共纳入66例患者，中位年龄65岁，65岁以上患者占42%。大多数患者患有急性白血病（61%），干细胞来源包括匹配的兄弟姐妹供体（18%），匹配的非亲属供体（33%）和单倍体供体（48%）。41%的患者Karnofsky Performance Status (KPS)≥90,86%的患者造血细胞移植合并症指数（HCT-CI）评分为0-2。累积疾病评定量表-老年（CIRS-G）评分中位数为5分。共有12%的患者有肾功能不全。在中位32.5个月的随访中，2年非复发死亡率（NRM）、无进展生存期（progression-free survival）和总生存期（OS）分别为21%、55%和58%。多变量分析，年龄>；65岁（HR 3.84, p = 0.027）和肾功能不全（HR 6.28, p = 0.005）与NRM风险增加相关。同样，age >；65岁（HR 2.75, p = 0.03）和肾功能不全（HR 3.46, p = 0.01）的OS较差。KPS、HCT-CI、CIRS-G、白蛋白、体重指数和多药均不能预测NRM和OS。结论：本研究支持同种异体造血干细胞移植作为老年人血液系统恶性肿瘤治疗选择的可行性。纳入老年评估的前瞻性研究将允许个性化移植策略改善移植后结果。试验注册：作者已确认本次提交不需要临床试验注册

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EJHaem

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