Analysis of the Serum Free Light Chain Ratio and Its Prognostic Value in a Cohort of Patients with Chronic Lymphocytic Leukemia.
Notice bibliographique
Résumé
Abstract Abstract 2631 Poster Board II-607 Introduction The measurement of immunoglobulin serum free light chains (sFLC) has prognostic value in the spectrum of plasma cell dyscrasias and has been evaluated in other B-cell malignancies. Its utility as a biomarker of potential prognostic value in B-CLL ( chronic lymphocytic leukemia ) was previously reported in a study of 259 patients in whom 39% had an abnormal sFLC ratio which was associated with a shorter time to first treatment and poor survival (Pratt et al. BJH. 2008). The objective of the present analysis was to identify if these findings are applicable to a previously untreated population of 125 patients accrued to NCIC CTG trial CL2 treated in a uniform manner and characterized for cytogenetic abnormalities, ZAP-70 expression and IgVH mutational staus. Patients & Methods Sera from 125 untreated patients, previously enrolled in a non-randomised, non-blinded, phase II study evaluating the efficacy of oral fludarabine (NCIC CTG CL2 trial), were analysed retrospectively. Median age was 61 yrs (range: 33–92) and 39% patients (49) were female. Rai staging system - Stage I: n=30, II: n=54, III: n=19, IV: n=22. Kaplan-Meier survival curves and log-rank test were used in summarizing and comparing survival distributions between sFLC ratio normal and abnormal groups, and COX regression analysis adjusting for prespecified baseline factors of ZAP-70, IGVH mutational status, sFLC and b2M were also performed to compare the two groups. Results 83/125 (66%) patients showed an abnormal sFLC ratio (<0.26 or >1.65). Table 1 summarises the results. b2M was the only baseline factor showing a statistically significant association with the sFLC ratio (p=0.01). A total of 33 patients died over the course of the study (21 had an abnormal sFLC ratio vs 12 with a normal sFLC ratio), including 20 deaths attributed to the disease and/or its treatment (13 with abnormal sFLC ratios vs 7 with normal sFLC ratios). No statistically significant difference was found, either for overall survival (OS) or for treatment free survival (TFS) between patients with normal and abnormal sFLC ratios. However, patients with abnormal sFLC ratios did show a borderline significantly worse progression free survival (PFS) (HR= 1.48, 95% C.I. 0.97 – 2.28, p = 0.07), even after adjustment for pre-specified baseline factors (HR = 1.48, 95% C.I. 0.94 -2.34, p = 0.09). Furthermore, in patients with mutated IGVH, those with with an abnormal sFLC ratio had a significantly shorter PFS (HR = 2.76, 95% V.I. 1.1 – 6.9, p=0.02). COX regression analysis for OS found that age (> 65yrs), gender (male), and stage (III or IV) were poor prognostic factors. sFLC ratios were not significantly associated with response rates (60% vs. 69%, p = 0.33) Conclusions 1) In this study of patients with untreated CLL with an indication for therapy, the frequency of an abnormal sFLC ratio is higher than previously reported i.e. 66% vs 44% (Martin et al. Trans Res. 2007) and 39% (Pratt et al. BJH. 2009). 2) The relation between IgVH mutational status and sFLC ratio needs further investigation. 3) The role of sFLC ratio as a prognostic biomarker in CLL should be evaluated in prospective trials of therapy in CLL. Disclosures: No relevant conflicts of interest to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».