Allogeneic Hematopoietic Cell Transplantation for Older Patients: Prognosis determined by Disease Risk Index

摘要

The treatment of elderly patients with advanced hematological malignancies has expanded to include reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (alloHCT) as a potentially curative option. We studied the association between disease risk index (DRI) and clinical outcomes of 196 elderly patients (median age: 64.8 [60-75] years) with hematological malignancies receiving RIC alloHCT (2000-2014). Donors were adult related and unrelated (RD, URD; n = 100, 51.1%) or umbilical cord blood (UCB) (n = 96, 48.9%). DRI classified 12 patients (6.1%) as low risk (LR), 146 patients (74.5%) as intermediate risk (IR) and 38 patients (19.4%) as high-risk (HR). Two-year overall survival (OS) was 47% (52% for LR/IR vs. 29% for HR; p<0.01) and two-year disease-free survival (DFS) was 39% (44% for LR/IR vs. 21% for HR; p<0.01). Relapse incidence was 30% (26% for LR/IR vs. 44% for HR; p<0.01). Treatment-related mortality (TRM) was 29% at 2 years; this was similar for all DRI groups. In multiple regression analysis, HR DRI was associated with increased risk of relapse (HR=2.07; 95% CI 1.34-3.33; p=0.02) and treatment failure (HR=2.07; 95% CI 1.35-3.18; p<0.01), and decreased OS (HR=2.11; 95% CI 1.34-3.33; p<0.01). In elderly patients, DRI is a significant prognostic factor for post-transplant relapse, treatment failure, and mortality. Due to increased risk of relapse leading to poor survival in HR DRI, participation in clinical trials offering relapse prevention strategies after RIC alloHCT should be encouraged when available.