EFFICIENCY AND SAFETY OF STEM CELL MOBILIZATION FOLLOWING GDP SALVAGE IN PATIENTS WITH RELAPSED OR REFRACTORY LYMPHOMA
Notice bibliographique
Résumé
Background: High-dose chemotherapy and autologous stem cell transplant (ASCT) remains a key treatment strategy in patients (pts) with relapsed/refractory (R/R) aggressive lymphoma. After CCTG study LY.12 (Crump, et al, JCO 2014) established gemcitabine, dexamethasone and cisplatin (GDP) as standard salvage chemotherapy regimen at our centre, we replaced our previous mobilization strategy using cyclophosphamide + etoposide (CE) with PBSC collection using GDP. The aim of this study was to compare the efficiency, resource use and ASCT outcomes of PBSC mobilisation with GDP to CE. Methods: All pts undergoing PBSC mobilization following salvage GDP for R/R lymphoma from 1/2012 to 8/2018 were included in this analysis. CE comprised C 2 g/m2 d1, E 200mg/m2 d 1-3 + GCSF 10μg/kg d4-12, with apheresis planned d13. For collection following GDP, GCSF was added 10μg/kg d9-14, apheresis starting d15. Leukapheresis started when the blood CD34 count was >10 cells/μl (target >5 x 106 CD34 cells/kg). From May 2014 plerixafor 24 μg/kg was added to GCSF for slow or inadequate mobilization. Primary outcomes were PB CD34 count on planned day of apheresis and total CD34 cell yield. Secondary outcomes included number of apheresis days, febrile neutropenia after mobilisation, engraftment, hospital stay, transfusions, PFS and OS. Results: A total of 339 pts underwent PBSC mobilisation, 210 following GDP and 129 after CE. Pts in GDP group had more delays from planned to actual day of collection (mean 0.7 vs 0.4 days, p=0.006) and required more days of apheresis (mean, 1.7 vs 1.5 days, p = 0.001). The percentage of GDP pts collected on planned day of harvest and who required only one day of apheresis were 71% and 50%, versus 84% and 69% respectively after CE. In multi-variable analysis, CE led to both higher PB CD34 count on planned day of harvest and higher total CD34 yield (both p<0.001), despite a higher rate of plerixafor use in the GDP group (36/210 vs y/129). When considering a target CD34 yield ≥5x106/kg there was no difference between mobilization regimens (p=0.66). Similarly, on multivariable analysis, febrile neutropenia during mobilization, days to engraftment, ASCT admission duration and platelet transfusions did not differ between the two strategies; pts mobilized with CE required more RBC transfusion during ASCT (p=0.04). Prior BM involvement and plerixafor use were independent predictors for longer engraftment (p=0.013 and p=0.007 respectively), irrespective of regimen and CD34 yield. In multi-variable Cox analyses, disease status at time of ASCT was the main predictor of PFS and OS. Conclusions: CE+GCSF appears to be a more efficient mobilization method than GDP+GCSF with regard to number and timing of leukapheresis in pts undergoing GDP salvage for R/R lymphoma; however this did not translate to significant differences in engraftment or length of hospital admission. Keywords: autologous stem cell transplantation (ASCT); gemcitabine; salvage treatment.
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 | 0,000 | 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 ».