Recently, the hematopoietic stem cell transplantation team from Department of Hematology of the First Affiliated Hospital (FAH) of Xi'an Jiaotong University (XJTU) broke the "forbidden area for the elderly" and successfully performed hematopoietic stem cell transplantation for a 70-year-old patient with high-risk acute myeloid leukemia complicated with double primary cancers, who is the oldest patient undergoing allogeneic transplantation in FAH.
The 70-year-old patient, surnamed Sun (not his real name), was diagnosed with acute myeloid leukemia with secondary myelofibrosis. Allogeneic hematopoietic stem cell transplantation is the only approach to cure the disease. According to clinical experience, most patients undergoing this transplantation are aged under 65. He had a history of laryngeal cancer and colon cancer, and the risk of transplantation was extremely high. His family members visited several hospitals for consultation and hematopoietic stem cell transplantation was not recommended.
In recent years, Transplantation Center of FAH has modified the transplantation procedures, designed an efficient and low-toxic bone marrow pretreatment protocol and formulated an individualized whole-process management regimen for elderly patients, achieving excellent transplantation effect in elderly patients aged> 60 years old and letting more and more elderly patients have the opportunity to receive hematopoietic stem cell transplantation. Elderly patients aged≥ 70 years with normal organ function can also undergo hematopoietic stem cell transplantation. Director He Pengcheng led the transplantation team to comprehensively evaluate the patient's disease status and the function of various organs. After extensive discussion before transplantation, the team decided to adopt an innovative individualized pretreatment regimen to perform haploidentical hematopoietic stem cell transplantation for this patient.
On September 3, 2024, the patient received 6-day pretreatment to remove leukemia cells from the body. During this period, the patient only presented with slight nausea without vomiting, severe liver and kidney function damage or cardiac insufficiency, and safely overcame the pretreatment stage. On September 11, hematopoietic stem cells were extracted from peripheral blood of his son and transfused into the patient. Due to the history of laryngeal and intestinal surgery, complications related to oral cavity, throat and intestine are prone to occur during transplantation. In the process of waiting for hematopoietic reconstruction after cell transfusion, Head Nurse Fan Ting led the nursing team to deliver daily assessment and nursing care for the oral cavity and perianal area of the elderly patient, and provided guidance for a reasonable diet. Deputy Director Wang Xiaoning led the transplantation team to closely observe the complications and adjust the medication regimen in a timely manner. At 11 days post-transplantation, granulocyte reconstruction was initiated, the platelets were reconstructed 13 days after transplantation, and the bone marrow was completely relieved at postoperative 18 days. Both the donor and recipient were in a state of complete chimerism, suggesting that the transplantation was successfully performed. During this period, the patient did not experience respiratory tract or intestinal infection and acute graft-versus-host disease. In addition, all indexes were normal. On September 30, 2024, he was discharged from FAH.
