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J Chin Med Assoc. 2020 Jan 2. doi: 10.1097/JCMA.0000000000000255. [Epub ahead of print]

European Group for Blood and Marrow Transplantation score correlates with outcomes of older patients undergoing allogeneic hematopoietic stem cell transplantation.

Chien SH1,2,3, Liu YC2,4, Liu CJ2,4, Ko PS2,4, Wang HY2,4, Hsiao LT2,4, Lin JS1,2, Chiou TJ1,2, Liu CY1,2, Gau JP2,4.

Author information

1
Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
2
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
3
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
4
Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

Abstract

BACKGROUND:

Acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) are hematological diseases predominantly occurring in older patients. Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the curative therapy for refractory AML or high-risk MDS, old age is often a hurdle to the procedure. We conducted a retrospective study to analyze the prognostic factors predicting outcomes of older patients undergoing allo-HSCT for acute leukemia and MDS.

METHODS:

We collected data from patients diagnosed with acute leukemia or MDS, who underwent allo-HSCT at age more than 50 years and reviewed clinical characteristics including age, sex, underlying disease, European Group for Blood and Bone Marrow Transplantation (EBMT) risk score, and presence of acute graft-versus-host disease (aGVHD) or chronic GVHD (cGVHD). The Cox proportional hazard model was adopted to explore the independent prognostic factors for overall survival (OS), progression-free survival (PFS), and non-relapse mortality (NRM).

RESULTS:

A total of 85 older patients were included, with the median age at allo-HSCT being 55 years. The significant prognostic factors for worse OS or PFS were an EBMT risk score > 3 and grade III-IV aGVHD, while patients with moderate to severe cGVHD would have better OS or PFS. Interestingly, it's not chronic GVHD but grade III-IV aGVHD that significantly correlated with NRM.

CONCLUSION:

This cohort study suggests that an EBMT risk score > 3 and grade III-IV aGVHD predict poor outcomes, and careful management of GVHD may allow better survival for older patients undergoing allo-HSCT.

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