PS1534 EFFICACY AND SAFETY OF STEM CELL MOBILISATION 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 with relapsed/refractory (R/R) aggressive lymphoma. CCTG study LY.12 established gemcitabine, dexamethasone and cisplatin (GDP) as a standard salvage chemotherapy regimen for R/R lymphoma across Canada. Peripheral blood stem cell (PBSC) mobilisation on this salvage regimen can be achieved using granulocyte colony‐stimulating factor (GCSF) during salvage (GDP) or following an additional course of cyclophosphamide and etoposide (CE) at completion of salvage GDP; however these strategies have yet to be compared. Aims: To compare the efficacy and safety of PBSC mobilisation with GDP to our previous standard of CE since GDP was adopted as standard salvage therapy for R/R lymphoma. Methods: All patients undergoing PBSC mobilisation following salvage GDP for R/R lymphoma from January 2012 to August 2018 were included in this analysis. CE comprised C 2 g/m 2 d1, E 200 mg/m 2 d 1–3, and GCSF 10 μg/kg d4–12, with apheresis planned d13. For collection following GDP, GCSF was added 10 μg/kg d9–14, apheresis starting d15. Apheresis started when the blood CD34 count was ≥10 cells/μl, with target collection of ≥5 x 10 6 CD34+ cells/kg. From May 2014 plerixafor 24 μg/kg was added to GCSF in the event of slow or inadequate mobilisation. Primary outcomes were PB CD34+ count on planned day of apheresis and total CD34+ yield. Secondary outcomes included number of apheresis days, febrile neutropenia after mobilisation, time to engraftment, days admitted for transplant, blood product usage, PFS and OS. Results: A total of 339 patients underwent PBSC mobilisation, 210 following GDP and 129 after CE. Patients in the 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 total days of apheresis (median 2 vs 1 day; p = 0.001). The percentage of GDP patients collected on planned day of harvest and who required only one day of apheresis were 71% and 50% respectively, versus 84% and 69% respectively after CE. ROC curves (Figure 1) for platelets, neutrophils and PB CD34+ measured on planned day of collection confirm PB CD34+ as the best predictor for successful attainment of target CD34+ yield. In multivariable 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 (37/210 vs 6/129). However, when considering a target total CD34+ yield ≥5x10 6 /kg there was no difference between mobilisation regimens (p = 0.66). Similarly, on multivariable analysis, days to engraftment, ASCT admission duration and platelet transfusions required showed no statistical difference between the two mobilisation strategies; patients mobilised with CE required more RBC transfusion during ASCT (p = 0.04). Of interest, prior bone marrow involvement and use of plerixafor were both predictors for longer engraftment time (p = 0.013 and p = 0.007 respectively), after adjustment for mobilisation and CD34+ yield. Although total CD34+ yield was not associated with days to engraftment on multivariable analysis, it was independently associated with blood product usage and day 100 blood count recovery. In multivariable Cox analyses, disease status at time of ASCT was the main predictor of PFS and OS. Summary/Conclusion: While CE/GCSF appears to be a more efficient method of mobilisation in patients undergoing GDP salvage for R/R lymphoma, this did not translate to significant differences in clinical outcomes such as engraftment or duration of hospital admission. image
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) | 0,000 | 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) | 0,000 | 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 ».