Autologous Stem Cell Transplantation (ASCT) in Multiple Myeloma (MM) Patients over Age 70.
Notice bibliographique
Résumé
Abstract Introduction: MM is a disease of the elderly with a median age of 65 years at diagnosis. Melphalan-based ASCT is standard therapy for younger (<60–65 years) MM patients (pts). However, limited data are available on the efficacy of ASCT in pts over age 70 with concerns of excess toxicity and transplant-related mortality (TRM). Methods: In this retrospective study, we examined the feasibility of ASCT in 33 MM pts ≥ age 70 (median age 71 yrs; range 70–74) who underwent this procedure at Princess Margaret Hospital from October 2000 to August 2006. As per institutional standard, all pts received 3–6 cycles of high-dose dexamethasone (DEX)-based induction therapy (VAD or DEX-alone) and underwent standard stem cell mobilization with cyclophosphamide 2.5g/m2 and GCSF 10mg/kg/day. Routine ciprofloxacin prophylaxis and GCSF use (from day 7) were used during the transplant process. Results: Nineteen pts(58%) were male. Baseline lab values (at time of transplant) were as follows: median hemoglobin 106g/L(range 83–144), WBC 6.7x109/L(range 1.9–11.9), platelets 191x109/L(range 103–319) and creatinine 69mmol/L(range 43–191mmol/L). Pre-transplant ECOG was 0–2 for all pts. Co-morbidities were reported for 29 pts(88%) and included prior solid tumours(18%) and cardiac disorders (arrhythmia, infarction) (15%). MM isotypes included: IgG 22(67%), IgA 6(18%), IgD 1 (3%), biphenotypic IgA/IgM 1(3%), nonsecretory 3(9%). A median of 9.1x106 CD34 cells/kg body weight (range 2.2–25.4x106cells/kg) were collected. Median time to engraftment of neutrophils and platelets was 12 days(range 9–13) and 11 days(range 8–15), respectively. Median duration of hospitalization was 15 days (range 12–40). Transfusion support (red cells and/or platelets) from time of stem cell collection to day 100 post-ASCT was required in 30/33 (91%) pts. Responses (all PR) were achieved in 24/27 pts (89%) with measurable disease. At a median follow-up of 18.3 months (mos) post-transplant, 16 pts (50%) relapsed and 14 (44%) died (follow-up data available in 32 pts). Median progression-free survival (PFS) was 23.3 mos; median overall survival (OS) was 41.2 mos from transplant. Three-year PFS and OS were 70% and 38%, respectively. TRM was 0%. Most common toxicities included: fever(67%), mucositis(46%), infections(46%), diarrhea(42%) and cardiac arrhythmias(18.2%) [all CTC grade 1–2]. Grade 3–4 toxicities were uncommon and included: myocardial infarction(6%), diarrhea(3%) and mucositis(3%). Overall, cardiac toxicities were more frequent than expected. The relationship between pre-ASCT parameters (e.g. isotype, lab values at transplant, co-morbidities and number of stem cells collected) and outcomes (e.g. PFS, OS, grade 3–4 toxicities) were assessed by univariate analysis. A higher number of CD34 cells harvested correlated with shorter days to neutrophil and platelet engraftment (p<0.0008) and prolonged PFS (p=0.043). Pts with IgA vs. IgG or other subtypes had a shortened PFS post-transplant (p=0.003). No significant predictors of OS or grade 3–4 toxicities were identified. Summary: Our preliminary data suggest that ASCT is feasible and generally well-tolerated in selected elderly (≥ 70 yrs) MM pts. Although toxicities, in particular cardiac, appear more common in this population, PFS and OS are comparable to that in younger pts and TRM was not elevated. We support consideration of very elderly pts for ASCT but encourage careful co-morbidity screening pre-transplant.
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 | 0,000 | 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 ».