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 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) | 0,001 | 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) | 0,000 | 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.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».