Early Recovery of Absolute Lymphocyte Count (ALC) Is a Predictor of Long-Term Outcome Following Related Allogeneic Peripheral Blood Stem Cell Transplantation in Adults with AML/MDS.
Notice bibliographique
Résumé
Background: Early recovery of absolute lymphocyte count (ALC) is associated with improved outcomes following allogeneic and autologous stem cell transplantation for various hematological malignancies. The mechanism(s) underlying this observation is (are) unknown, but lymphocyte recovery may be a marker of immune reconstitution or graft-versus-leukemia activity. Objective: We assessed the incidence of early ALC recovery (defined as ALC ≥ 0.5 x 109/l by day+30) after peripheral blood stem cell transplantation (PBSCT) in recipients transplanted for AML or MDS and investigated its role as a potential prognostic marker for post PBSCT outcomes. Methods: We reviewed the cases of 110 consecutive patients who underwent first allogeneic PBSCT from related donors for a diagnosis of AML (n=92) or MDS (n=18) at the Princess Margaret Hospital (Toronto, Canada) between 2000 and 2007. All patients received related donor transplants (matched related, n=103; mismatched related, n=7) and were alive at day+30. The primary outcome measure was incidence of early ALC recovery at day +30 post PBSCT. Endpoints were overall survival (OS), non-relapse mortality (NRM) and relapse incidence (RI) after PBSCT according to day +30 ALC ≥ 0.5 x 109/l (high ALC group) or < 0.5 x 109/l (low ALC group). Results: The cohort included 51 women and 59 men. Median age at PBSCT was 51.7 years (range 18–71 years). Myeloablative conditioning (MAC) was employed in 65 (59%) patients (TBI based, n=62; Busulfan based, n=3), and 45 (41%) received reduced intensity conditioning (RIC). Median follow-up for survivors was 32 months. ALC ≥ 0.5 x 109/l by day+30 was reached by 72 patients (66%). There was no association between recipients’ gender, age at PBSCT or type of conditioning regimen and the probability of attaining ALC ≥ 0.5 x 109/l by day+30. Two-year OS in the entire cohort was 61%. Two-year OS of the high ALC group was superior to that of the low ALC group (72% vs. 40%, p=0.0003) (Figure 1A). The high ALC group also had significantly lower NRM (16% vs. 35%, p=0.005) (Figure 1B) and RI (21% vs. 42%, p=0.003) compared to the low ALC group (Figure 1C). No association between early ALC recovery and the incidences of acute or chronic graft-versus-host disease or incidence of CMV reactivation was observed. On multivariate analyses, low ALC at day +30 (ALC < 0.5 x 109/l) was an independent prognostic factor for inferior OS (p=0.02, HROS=2.27), higher RI (p= 0.01, HRRI=3.18), and higher NRM (p=0.03, HRNRM=2.1). Conclusion: In AML and MDS early lymphocyte recovery by day 30 is associated with improved OS. Failure to attain early ALC recovery may identify patients with higher risk of relapse and NRM after PBSCT. Figure 1. Comparison of transplant outcomes between groups with high and low ALC counts at day 30 in terms of survival (A), non-relapse (C). Figure 1. Comparison of transplant outcomes between groups with high and low ALC counts at day 30 in terms of survival (A), non-relapse (C).
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 | 0,001 | 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 ».