Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 635

The only possible definitive cure for MDS is represented by allogeneic HSCT.^81‐83 For many years, older age was considered per se a contraindication to transplant, mainly because of the intensive, myeloablative conditioning chemotherapeutic regimens used. The development of reduced‐intensity conditioning approaches has made HSCT an option even for fit older adults. This treatment modality seeks to maximize the immune effect of graft versus leukaemia while minimizing the toxicity associated with ablative conditioning regimens. Non‐myeloablative transplantation has a low short‐term mortality rate in patients with MDS up to age 70–75 with overall survival rates comparable to those for ablative transplantation, mainly due to the higher risk of relapse.⁸⁴

In a large retrospective study conducted in the US, 1106 patients ≥70 underwent HSCT. The proportion of allogenic HSCT increased over time (from 0.1% in 2000 to 3.85% in 2013; total number: 298). Acute myeloid leukaemia and myelodysplastic syndromes represented the most common disease indications. Two‐year OS and PFS significantly improved over time (OS: 26% in 2000–2007 to 39% in 2008–2013; PFS: 22% in 2000–2007 to 32% in 2008–2013, P = .003). Two‐year treatment‐related mortality ranged remained unchanged over time (33–35%). Higher comorbidity and myeloablative conditioning were associated with higher mortality rates.¹⁰²

Again, undertaking CGA is crucial in selecting the candidates for transplantation.