Lymphocyte Recovery At Day 28 Post-Transplant Is Predictive Of Relapse In Patients With Acute Myeloid Leukemia Transplanted With Peripheral Blood Stem Cell Grafts
Notice bibliographique
Résumé
Abstract Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative treatment option for patients with acute myeloid leukemia (AML). The impact of lymphocyte recovery on post- transplant outcomes has been suggested but has not been evaluated in a homogeneous population of AML patients. The present study attempted to evaluate the impact of lymphocyte recovery at 28 days post-HCT in a homogeneous population of 212 patients with AML that underwent HCT between 1999 and 2011 at the Princess Margaret Hospital, Toronto, Canada. All patients in the study group received peripheral blood stem cells as a graft source. Patients were divided into two groups: those with absolute lymphocyte count (ALC) ≥0.5x109/L (n=122, 57%) and those with ALC <0.5x109/L (n=90, 43%), at day 28 post-transplant. Median age of all patients was 49 years (range 18-70), 102 patients (48%) were female. HCT was performed in first complete remission (CR1) for 134 patients (63%) and second complete remission (CR2) for 78 patients (37%). Cytogenetics at diagnosis were available in 189 patients (89%). Donors were matched related (n=145, 68%) or matched unrelated (n=67, 32%). Myeloablative conditioning was administered to 131 (62%) patients, 81 (38%) received reduced-intensity conditioning (RIC) regimens. Median follow up duration among survivors was 49 months (range 7-120 months). Univariate analysis demonstrated overall survival (OS) was significantly different in favor of the group with ALC ≥0.5x109/L vs those with ALC <0.5x109/L (p=0.016) with a 3-year OS of 57% vs 39% respectively. The cumulative incidence of relapse (CIR) was significantly lower in the group with ALC ≥0.5x109/L vs those with the ALC <0.5x109/L (p=0.0002), with a 3-year CIR of 16% vs 37% respectively (Figure). Cumulative incidences of non-relapse mortality (NRM) were not significantly different between the two groups (p=0.22). Multivariable analysis for OS and NRM did not demonstrate ALC ≥0.5x109/L at 28 days post-transplant to be an independent prognostic factor. Multivariable analysis for CIR demonstrated that ALC ≥0.5x109/L at 28 days post-transplant is an independent prognostic factor decreasing the risk of relapse compared to ALC <0.5x109/L (p=0.015, HR=0.47, 95%CI=0.25-0.86), which implies that early lymphocyte recovery suggests lower risk of relapse post-transplant. Significant decrease in CIR was also seen with the occurrence of chronic graft-versus-host disease (GvHD) (p=0.00002, HR=0.29, 95%CI=0.16-0.51), while increased CIR was associated with the use of RIC regimens (p=0.03, HR=1.9, 95%CI=1.1-3.5). The present study concludes that lymphocyte recovery with ALC ≥0.5x109/L at day 28 post transplant is associated with decreasing risk of relapse in a homogeneous population of AML patients that underwent allogeneic peripheral blood HCT, but without overall survival benefit. 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 | 0,000 | 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 | 0,001 | 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 ».