OUTCOME OF PRIMARY MEDIASTINAL LARGE B‐CELL LYMPHOMA IN THE RITUXIMAB ERA: IMPACT OF A PET‐GUIDED APPROACH
Notice bibliographique
Résumé
Background: Primary mediastinal large B-cell lymphoma (PMBCL) is a rare subtype of lymphoma which typically presents in females with a bulky anterior mediastinal mass. Patients (pts) are treated with chemoimmunotherapy ± consolidative radiotherapy (CRT). Herein, we reviewed outcomes of PMBCL pts treated at BC Cancer in the rituximab era and the impact of a PET-adapted approach. Methods: The BC Cancer Lymphoid Cancer Database was used to identify pts >16 years (y) of age with newly diagnosed PMBCL based on the WHO classification who were treated with chemotherapy + rituximab. Prior to the availability of FDG-PET scan at end of treatment (EOT) in July 2005, all pts were recommended to receive R-CHOP and CRT (RT era, n=50). Since the availability of an EOT PET (PET era, n=109), only pts with a positive EOT PET (PETpos) were recommended to have CRT. Before 2014, PET scans were interpreted based on the International Harmonization Project (IHP) and after 2014 the Deauville (D) criteria (D1-3, DX = PETneg). IHP era PET scans were retrospectively reclassified using D criteria. Results: 159 pts with PMBCL were identified with a median follow up of 7.9 y (range 0.7 – 16.7 y) and the following characteristics: median age 36 y (range 19-84); 57% female; 70% bulky >10cm; 40% pleural/pericardial effusion; 37% extranodal sites >1; 43% B symptoms; 72% elevated LDH; 63% stage I/II. Pts received R-CHOP (n=149), R-CHOP/R-ICE (n=8) or DAEPOCH-R (n=2). 70 pts (44%) received CRT, 78% (n=39) in the RT era (2001-2005) and 28% (n=31) in the PET era (>2005). The 5y time to progression (TTP) and overall survival (OS) for the entire cohort were 80% and 89%, respectively. In a treatment era comparison, there was no difference in TTP (78% vs 81%, P=0.74) and OS (86% vs 91%, P=0.26) for pts treated in the RT vs PET era, respectively, with only one pt in the PET era not having a PET scan due to disease progression. 113 pts had an EOT PET which included 10 pts who had a self-pay PET: PETneg n= 71 (63%), of which 1% (n=1) received CRT; PETpos n=42(37%), of which 79% (n=33) received CRT. For all 113 pts treated with a PET guided approach, the 5 y TTP and OS were 83% and 94% respectively. For PETneg and PETpos cases, the 5 y TTP were 88% vs 74% (P=0.03) and 5 y OS were 97% vs 88% (P=0.78), respectively. All centrally performed PET scans pre-2014 (n=59) were reassigned by D criteria for a total of 103 D assigned cases; 71% PETneg; 29% PETpos. The 5 y TTP and OS for PETneg by D were 90% and 97%, respectively. For PETpos cases, outcomes were inferior for D5 (n=12) vs D4 (n=18): 5y TTP 33% vs 94% (P<0.0001); 5 y OS 67% vs 100% (P=0.002). Keywords: positron emission tomography (PET); primary mediastinal large B-cell lymphoma (PMLBCL); R-CHOP. Disclosures: Villa, D: Consultant Advisory Role: Roche, Lundbeck, Celgene, Abbvie, Seattle Genetics, Janssen, AstraZeneca, Gilead, Nanostring. Gerrie, A: Consultant Advisory Role: Janssen, AbbVie, Novartis; Research Funding: Roche, Lundbeck, Janssen. Scott, D: Consultant Advisory Role: Celgene and Janssen; Research Funding: Janssen, Roche/Genentech and NanoString. Freeman, C: Consultant Advisory Role: Celgene, Janssen, Amgen, Seattle genetics, Abbvie; Research Funding: Roche/Genentech. Pickles, T: Consultant Advisory Role: Sanofi, Astellas, Servier, Abbvie, Bayer, Ferring. Connors, J: Research Funding: Amgen, Bayer, Bristol-Myers Squibb (Inst), Cephalon (Inst), Genentech/Roche (Inst), Janssen Oncology (Inst), Lilly (Inst), Merck (Inst), NanoString Technologies (Inst), Roche, Seattle Genetics, Takeda. Sehn, L: Consultant Advisory Role: Roche/Genentech, Abbvie, Amgen, Apobiologix, Astra Zeneca, Acerta, Celgene, Gilead, Janssen, Kite, Karyopharm, Lundbeck, Merck, Morphosys, Seattle Genetics, Teva, Takeda, TG Therapeutics; Research Funding: Roche/Genentech. Savage, K: Consultant Advisory Role: BMS, Merck, SeaGen, Verastem; Honoraria: Takeda; Research Funding: Roche.
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 | 0,002 |
| 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 | 0,001 | 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 ».