High Dose Aracytine, Rituximab, and Dexamethasone Based Chemotherapy for Elderly Patients with Mantle Cell Lymphoma.
Notice bibliographique
Résumé
Abstract Mantle cell lymphoma (MCL) mainly affects elderly and long term response to standard chemotherapy is deceiving. The addition of Rituximab or high dose chemotherapy regimens may improve these results, but have not been evaluated in elderly patients or those with significant comorbidities. We thought to evaluate the safety and efficacy of a High dose Aracytine (Cytosine arabinoside), Rituximab and Dexamethasone (HARD) chemotherapy regimen in elderly patient with aggressive mantle cell lymphoma. Patients and methods: All patients with relapsing, refractory or de novo aggressive MCL were eligible despite comorbidities. All received Rituximab 375 mg/m2 and Dexamethasone 40 mg/d x3 days per cycle. The dose of Aracytine was modulated according to the general condition and accompanying comorbidities. Revised data included clinical and biological parameters, pathology specimens, CT and PET scans. Comorbidities were assessed according to medical records. Patients who received at least one cycle of HARD were analysed for tolerance; and those who completed scheduled treatment or with treatment interruption due to intolerance or insufficient response were analysed for efficacy. Results: Between November 2005 and August 2007, eight consecutive MCL patients, 5 males, 3 females; median age 72.6 years (65–77) were treated by HARD based chemotherapy. All presented with aggressive histological pattern and stage III/IV disease. The majority had performance score >2 (6/8), high serum LDH (6/8), high β2microglobulin (5/5) and Hemoglobin level <12 g/dL (5/8). The FLIPI score was High/High-Intermediate in seven patients. The Charlson comorbidity score was >5 for seven patients and principal documented comorbidities were coronary heart disease (3/8), cardiac systolic dysfunction (3/8), cerebrovascular diseases (3/8), chronic renal insufficiency (4/8), and chronic respiratory disorders (3/8). A total number of 27 HARD cycles were given. All received planned doses of Rituximab and dexamethasone. The median initial dose of Aracytine was 2.55 g/m2 (1.12–4 g/m2), which was subsequently modified according to tolerance. Five patients also received at least one cycle of concomitant Cisplatinum (average dose 20–60 mg/m2). Primary prophylactic G-CSF was given to 5 patients. There were five episodes of thrombopenia and five episodes of anemia requiring transfusions. One patient developed acute transfusion reaction complicated by myocardial infarction, pulmonary edema and acute renal failure that responded to medical treatment. One cycle of HARD was complicated by febrile neutropenia. There was no treatment associated mortality. Two patients are still under treatment and are only evaluated for tolerance. Two other patients were refractory to one and two cycles of HARD and died rapidly from disease progression. Of note that both had >150 x109circulating lymphoma cells/L at treatment. Four patients (67%) responded favourably: 3 complete remissions maintained with 22, 14 and 10 months of follow-up; and one partial remission that persisted for 15 months before progression. Conclusion: HARD is safe in elderly and fragile patients with MCL, provide that the dose is modulated according to comorbidities. Despite this dose modulation, the response rate seems very interesting and compares favourably with other regimens adapted for young and physically fit patients.
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 | 0,000 | 0,000 |
| 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) | 0,000 | 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 ».