Allogeneic hematopoietic stem cell transplantation in elderly patients with acute myeloid leukemia
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摘要: 老年急性髓系白血病(acute myeloid leukemia，AML)患者通常携带不利的分子和细胞遗传学异常。异基因造血干细胞移植已越来越多地应用于老年AML患者，5年存活率较化疗组显著提高。近期国内指南已将老年AML患者异基因移植年龄提高到65岁，而且对于部分符合条件的年龄 < 70岁的老年AML患者，亦可开展非清髓异基因移植。年龄≥60岁、HCT-CI≥2分、复发/难治，尤其是年龄≥70岁、HCT-CI≥6分、多次复发、CR3，与更高的死亡风险相关。国内老年AML患者接受异基因移植的比例远低于国外数据，仍面临巨大的社会需求和发展潜力。优化移植前诱导方案引入低毒高效的靶向药物，降低预处理方案毒性，完善移植后管理，有助于提高长期生存率，降低移植相关死亡率和累计复发率。
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关键词:
- 急性髓系白血病 /
- 老年患者 /
- 异基因造血干细胞移植
Abstract: The elderly patients with acute myeloid leukemia(AML) usually carry unfavorable molecular and cytogenetic abnormalities. Allogeneic hematopoietic stem cell transplantation has been increasingly used in elderly AML patients, and the 5-year survival rate is significantly higher than that of chemotherapy group. Recently, domestic guidelines have raised the age limit of allogeneic transplantation for elderly AML patients to 65 years old, and non-myeloablative allogeneic transplantation can also be carried out for some eligible elderly AML patients younger than 70 years old. Age ≥60 years, HCT-CI≥2, relapsed or refractory diseases, especially age ≥70 years, HCT-CI≥6, more times of relapsing and CR3, are associated with higher risk of death. The proportion of domestic elderly AML patients receiving allogeneic transplantation is far lower than that of foreign data, and transplantation in elderly AML patients still faces great social needs and development potential. Further optimization of pre-transplant induction therapy, introduction of low-toxicity and high-efficiency targeted drugs, further reduction of conditioning toxicity and improvement of post-transplant management will help to improve long-term survival rate and reduce transplant-related mortality and cumulative incidence of relapse. -
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