Significant Improvement In Overall Survival In Patients Who Underwent Autologous Hematopoietic Cell Transplant In the US or Canada Between 1994 and 2005
Notice bibliographique
Résumé
Abstract Abstract 2389 Autologous hematopoietic cell transplantation (autoHCT) is standard therapy for high-risk hematologic disorders and solid tumors. We assessed whether overall survival (OS) at Day 100, which represents early transplant-related mortality (TRM), and at one year, which represents disease-related mortality and later TRM, had changed over time. The study population was derived from patients undergoing 68,404 first autoHCTs between 1994–2005 in US and Canadian centers reported to the CIBMTR. Statistical significance was measured using Ptrend over 6 time cohorts to test whether the OS estimates were stable (slope = 0), increasing (slope>0) or decreasing (slope<0) over time. The Day 100 and 1-year OS estimates are shown in the Table. Disease and disease status subgroups were defined a priori, and the OS estimates are not adjusted for any covariates such as age, Karnofsky status, etc. Mortality rates at Day 100 were, in general, low for all diseases examined and improved significantly over time for NHL in complete remission (CR) 2/sensitive 1st relapse, for lymphoma in primary induction failure (no prior complete remission) and myeloma in first partial or complete remission. Improvements in 1-year OS were seen for NHL in CR1/sensitive 1st relapse and myeloma in remission at the time of transplant. OS has improved for many patients undergoing autoHCT which likely reflects improvement in supportive care and better patient selection. Day 100 mortality rates in autoHCT patients treated during the most recent period 2004-5 are as low as 2–5% in patients with chemotherapy sensitive disease pre-autoHCT. Even in patients transplanted with resistant disease (no prior CR), the Day 100 mortality rate is only 5% in MM and 9% in HL/NHL patients. Although the 1-year OS has improved over time there is still a significant decline in OS between the Day 100 and 1-year time points, especially for patients with NHL in CR2/sensitive 1st relapse, lymphoma in primary induction failure and myeloma not in remission, suggesting a need for improved disease control in these patients. Table 1: Overall survival (95% CI) estimates over time. Autologous HCT 1994-5 1996-7 1998-9 2000-01 2002-3 2004-5 Ptrend NHL in CR2/Rel 1 sens N 890 1067 1041 1020 946 1116 <0.001 @100 days 89 (87–91) 90 (88–92) 90 (88–92) 94 (92–95) 94 (92–95) 95 (94–97) <0.001 @1 year 68 (65–71) 69 (66–72) 72 (69–75) 77 (75–80) 78 (75–80) 80 (77–83) HL in CR2/Rel1 sens N 384 384 466 435 477 573 0.4758 @100 days 95 (92–97) 95 (92–97) 96 (94–97) 97 (95–98) 96 (94–98) 97 (95–98) 0.1985 @1 year 86 (82–89) 87 (84–91) 87 (83–90) 89 (85–92) 90 (87–93) 91 (88–93) HL or NHL in PIF N 647 708 772 895 570 504 0.0299 @100 days 86 (84–89) 88 (86–90) 87 (84–89) 90 (87–92) 90 (88–93) 91 (89–94) 0.7532 @1 year 69 (65–73) 69 (65–72) 70 (67–74) 72 (68–75) 71 (67–75) 72 (67–76) MM in CR1/PR1/PIF sens N 267 541 718 1567 2423 3192 <0.001 @100 days 96 (94–98) 96 (94–98) 96 (94–97) 97 (96–98) 98 (97–98) 98 (98–99) <0.001 @1 year 83 (79–88) 84 (81–87) 87 (85–90) 90 (89–92) 92 (91–93) 92 (91–93) MM in less than PR N 105 177 392 420 521 586 0.3829 @100 days 92 (85–96) 94 (90–97) 96 (94–98) 96 (94–98) 97 (95–98) 95 (93–97) 0.0857 @1 year 79 (70–87) 79 (73–85) 86 (82–89) 88 (84–91) 88 (85–91) 87 (84–90) NHL – non-Hodgkin lymphoma, HL – Hodgkin lymphoma, MM – myeloma, CR – complete remission, Rel – relapse, PIF – primary induction failure, sens – sensitive Disclosures: No relevant conflicts of interest to declare.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 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 | 0,001 |
| 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 tête enseignante, pas un consensus.
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