Long-Term Results of Allogeneic Hematopoietic Stem Cell Transplantation Using Unrelated or HLA Mismatched Family Donors for Acute and Chronic Lymphoid Malignancy.
Notice bibliographique
Résumé
Abstract A substantial proportion of lymphoid malignancy cannot be cured with conventional therapy or autografting, and a matched family donor is available for less than 1/3 of patients (pts) who may benefit from an allograft. Alternate donors (AD) were therefore utilized with curative intent for 87 pts with acute or chronic lymphoid malignancy at the Leukemia/BMT Program of BC between 1983 and 2002. Long-term results for these pts who received stem cells from unrelated donors (UD) (n=73) or mismatched related donors (MMRD) (n=14) were analyzed. UDs were HLA matched in 58 cases for HLA A, B and DR, and mismatched at 1 or 2/6 loci in 15 pts. Related donors were mismatched at 1/6 (n=13) or 2/6 loci (n=1). Diagnoses included ALL in 37 (n=12 Ph+); NHL in 28 ( n=1 Burkitt’s; n=15 aggressive; n=12 indolent); CLL in 3, PLL in 1 and myeloma in 18 pts. Transplant occurred a median (med) of 10 months (range 1.6 mos-14.7 yrs) post diagnosis at a med age of 36 years (range 12–53). The majority (n=57, 66%) were not in CR at the time of transplant; 53 (61%) were male. GVHD prophylaxis included cyclosporine + methotrexate in 72, T-cell depletion in 11, and other in 2 pts. Conditioning was TBI based in the majority (n=80, 92%), and busulfan based in 7 pts (8%). Most (n=83, 95%) received marrow (m) only; 2 received peripheral blood (pb) and 2 pb+m. The med (range) nucleated cell count was 2.6 (0.2–15)x108 CD 34 cells/kg; graft failure was seen in 5 cases (6%). Acute (A) graft-versus-host disease (GVHD) grade 0/1, 2, 3 and 4, (n= %), was seen in 24 (28%); 24 (28%); 19 (22%) and 19 (22%) pts. The majority (n=41/56, 73%) who survived past day 100 developped chronic (C) GVHD. Thirty pts (35%) are currently alive, and 57 (65%) deceased a median of 96 days (range 12 days-4.2 years) post transplant. Death from relapse (n=19) occurred at a med of 1 year (range 17 days-4 years), and from transplant related causes (n=38) at a med of 71 days (range 12 days-17 months). Overall survival (OS) is 32% (95% CI 23–43%) at a med follow-up of 6 years (range 1–15 years); the curve is flat after 50 mos, and 17/30 survivors are out more than 5 years. Cumulative incidence estimates are as follows: acute GVHD (gr 2–4) 72%; (gr 3–4) 44%; chronic GVHD 73%; relapse 27%; non-relapse mortality (NRM) 44%. In univariate analysis AGVHD (3–4) impacted negatively on OS, event-free survival (EFS) and NRM. Relapse risk was higher in pts receiving TCD stem cells. Development of CGHVD was protective against relapse (p=0.03, relative risk = 0.37). In conclusion, one-third of pts with otherwise incurable lymphoid malignancy have achieved long-term disease-free survival using alternate donor stem cell transplant. Strategies to decrease transplant-related mortality are needed. Control of underlying disease remains imperfect, but not unacceptable with 27% long-term risk of disease recurrence. No relapse has occurred after 50 mos, with a plateau seen in the risk curve after 5 years suggesting cure even in pts with ALL or MM. Interestingly, a graft-vs-malignancy effect can still be demonstrated in this population with lymphoid malignancy and alternative donors, with decreased relapse risk seen in pts developing CGVHD.
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 | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 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 ».