Risk of Acute Leukemia Post-Autologous Stem Cell Tranplant (ASCT) for Hodgkin’s Lymphoma (HL) Depends on Choice of Salvage Chemotherapy and Use of Radiation.
Notice bibliographique
Résumé
Abstract Background: Late treatment-related mortality (TRM) and second cancers (SC) have an important impact on the long-term outcome of patients (pts) with HL. The optimum salvage regimen (based on efficacy and acute and late toxicity) as part of second-line therapy with ASCT is not known. Pts undergoing ASCT are at high risk of both solid tumors and leukemia (Proc ASCO 2007 abstr #8016). We analyzed our single-institution data to determine the contribution of the components of salvage therapy to leukemia risk post-transplant. Methods: From Dec 1986 to Nov 2005, 321 pts with relapsed/refractory HL after doxorubicin-based primary chemotherapy (+ involved/extended field radiation [RT]: 46%) received salvage chemotherapy to best response, followed by etoposide 60 mg/kg day-4 and melphalan 160–180 mg/m2 [day-3] supported by autologous bone marrow (46%), mobilized PBSCs (49%) or both (5%) [day 0]. 27% received involved field RT post-ASCT. Risk of treatment failure and second cancers was estimated using competing risks methods. Leukemia risk with time was determined by cumulative incidence function. Results: Patient characteristics: male: 61%; median age 33 yrs (range16–67). No. of salvage regimens pre-ASCT: 1: 76%; 2: 19%; ≥3: 5%. Salvage chemotherapy: BCNU, etoposide, cytarabine, melphalan (miniBEAM, [MB]) 162 (50%); cisplatinum-based regimens (dexamethasone, cytarabine, cisplatin [DHAP] or gemcitabine, dexamethasone, cisplatin [GDP]) 128 (40%); other 10%. Disease status post-salvage chemotherapy: CR 28%, PR 66%. With a median follow-up of 4.7 yrs post-ASCT (range 1–17), estimates of OS, PFS and disease relapse are 53%, 53% and 46% at 5 years, and 39%, 51% and 48% at 10 yrs. The cumulative incidence of treatment-related death (from toxicity or SC) continues to increase from 9% (6–13) at 3 years to 15% (11–20) 10 yrs post-ASCT. The probability of SC is 5% (2.8–7.8) at 3 years and 12% (7.9–16.7) at 10 years (leukemia risk: 7%, solid tumour risk: 5%). There have been a total of 154 deaths, 104 from progressive HL alone and 37 from treatment-related events - 14 (9%) of these were from SC with no evidence of relapsed HL. There were an additional 11 deaths from a combination of causes (relapsed HL and other), 9 (6%) of these were related to SC. 30 SC were identified, 12 solid tumors and 18 AML/MDS. The risk of secondary acute leukemia differs according to salvage chemotherapy received - 0.9% (0.1–6.2) and 3.4% (0.7–15.1) at 3 and 10 yrs respectively in DHAP/GDP pts, compared to 4.6% (2.2–9.4) and 9.1% (5.4–15.3) in pts treated with MB [p=0.051]. Pts who received radiation (pre- or post-ASCT) have a leukemia risk of 4% (1.8–8) at 3yrs increasing to 8.5% (4.9–14.4) at 10yrs, while pts who never received radiation had a stable leukemia risk of 1.8% (0.3–12%) [p=0.19]. Conclusions: In this single institution experience with HL pts undergoing ASCT with a consistent salvage therapy strategy, long-term survivors have an on-going increasing risk of SC and leukemia which contributes to late mortality. Specific components of therapy appear to influence this risk. Our observation of an unexpected increased risk of AML in HL patients receiving miniBEAM salvage prior to transplant suggests that the contribution of other salvage regimens to late adverse effects warrants further investigation.
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 | 0,001 | 0,003 |
| 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) | 0,003 | 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 ».