Abstract 4525: The impact of chemoimmunotherapy dose intensity in diffuse large b-cell lymphoma
Notice bibliographique
Résumé
Abstract Introduction Chemotherapy dose intensity (DI) impacts outcomes across tumor subtypes. In diffuse large B-cell lymphoma (DLBCL), DI played a large role prior to rituximab, but is still a subject of investigation. Research into intensifying treatment for poorer prognostic lymphoma subtypes has yielded dose-adjusted EPOCH-R where etoposide is added to standard R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Though, R-CHOP given every 14 vs. 21 days has not been found to improve survival, this study examines if delays in treatment or reductions in R-CHOP21 DI impact patient outcomes. Methods In this single institution review, DLBCL patients (pts) treated with first-line R-CHOP between 2004 and 2010 were included. After factoring in covariates such as revised International Prognostic Index (R-IPI) and gender, pts were compared by DI (ratio of actual total dose received vs. prescribed dose) of cyclophosphamide, doxorubicin, and treatment duration as a whole for their impact on progression-free (PFS) and overall survival (OS). Results Of 232 pts identified, 224 were included in final review. Median age and ECOG performance status was 62 years and 1, respectively. Majority had stage IV disease (46%). 124 patients were male with pts evenly distributed between R-IPI 0-1 (low, 28%), 2 (low-intermediate, 21%), 3 (high-intermediate, 26%), and 4-5 (high, 25%). A median DI of both cyclophosphamide and doxorubicin was 97%. 118 pts had >/ = 1 week delay during treatment duration. Cutpoint analysis found that DI was more important at 85% for both cyclophosphamide and doxorubicin. Median PFS for patients who received / = 85% cyclophosphamide DI was 27.2 vs. 55.0 months (hazard ratio [HR] 2.48, p = 0.03). Similarly, median OS was 41.8 months vs. not reached (HR 2.79 p = 0.02), respectively. PFS and OS for doxorubicin was similar at 27.6 vs. 53.7 months (HR 2.25, p = 0.04) and 40.9 months vs. not reached (HR 2.54, p = 0.02), respectively. Actual treatment durations that differed <15% of the planned durations were protective for PFS (HR 0.44, p = 0.008), but less so for OS (HR 0.63, p = 0.18). Taking R-IPI scores and gender in multivariate Cox proportional hazards modeling found the impact of cyclophosphamide and doxorubicin DI on PFS and OS maintained significance but not treatment duration. Though multiple reasons for reduced DI exist, growth factor support use trended towards higher DI pts (32 vs. 19%, p = 0.10). Conclusions While intensifying R-CHOP by shortening cycles to every 14 days has not been beneficial, this study suggests that delays and dose reductions in R-CHOP21 substantially impact outcomes. In doing so, it highlights that maintaining pts on schedule is important and that more accurate methods of determining appropriate chemotherapeutic doses may affect both survival and toxicity. Although it is our standard to only use growth factor support with delays it may be beneficial to starting all patients up front on growth factor support. Citation Format: Michael P. Chu, Sunita Ghosh, Andrew Belch, Neil S. Chua, Amelie Fontaine, Randeep Sangha, Robert Turner, Christopher Venner, Vickie Baracos, Michael B. Sawyer. The impact of chemoimmunotherapy dose intensity in diffuse large b-cell lymphoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4525. doi:10.1158/1538-7445.AM2015-4525
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 | 0,004 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 ».