PS1255 EFFICACY OF R-BAC IMMUNOCHEMOTHERAPY IN PATIENTS WITH RELAPSED, REFRACTORY MANTLE CELL LYMPHOMA POST BTK INHIBITOR THERAPY
Notice bibliographique
Résumé
Background: The prognosis of follicular lymphoma (FL) is considered favorable with rituximab-containing first-line chemotherapy (R-CHEMO1). However, many patients will eventually require second-line therapy, for which there is no current standard. Generally, patients receive a second course of rituximab-containing chemotherapy (R-CHEMO2) even though there are no prospective trials backing this approach. Aims: To characterize outcomes after R-CHEMO2 of patients with relapsed biopsy-proven grade 1–3A FL initially treated with R-CHEMO1 ± maintenance rituximab (MR). Methods: We did a retrospective study of consecutive patients from 6 Canadian centres, excluding patients with transformed FL and those who received second-line radiotherapy or chemotherapy alone. Results: 129 patients with FL, 48% female, were included. Characteristics at diagnosis were a median age of 56 years (range 20–81), 84% stage III/IV, 35% high-risk FLIPI. 33 (26%) were initially observed, and 5 (4%) initially received radiation. R-CHEMO1 was R-CVP in 95 (74%), R-CHOP in 29 (23%), BR in 4 (3%), and FR in one patient. 73 (57%) received MR1. The median time from start of R-CHEMO1 to start of R-CHEMO2 was 36 months (range 2–145), with progression within 24 months of R-CHEMO1 (POD24) in 49 (38%) patients. At start of R-CHEMO2, the median year was 2011 (range 2004–2017), the median age was 60 (range 22–82). 80% had stage III/IV, 44% high-risk FLIPI, 39% high LDH, 89% performance status 0–1. Second-line regimens included 40 (31%) BR, 19 (15%) R-CHOP, 19 (15%) R-CVP, 17 (13%) FR, 17 (13%) platinum-containing, and 17 (13%) other regimens. Overall response rate was 80% and complete response 37%. 40 (31%) patients received autologous stem cell transplantation (ASCT), 34 (26%) received MR2, and 5 received radiotherapy. With a median follow-up in living patients of 5.2 years (range 1.1–13.3) after R-CHEMO2, there have been 56 (43%) instances of progression (PROG2). 20 were biopsied (7 DLBCL, 13 FL) and 36 were not (2 aggressive and 34 indolent behavior). Median PFS2 was 6.4 years (95% CI 3.0–9.9) and 5-year PFS2 was 54% (95% CI 53–55). 31 (24%) patients progressed within 6 months of R-CHEMO2 or MR2. Age over 60 (HR 1.75, 95% CI 1.04–2.95, p = 0.036), ASCT (HR 0.26, 95% CI 0.13–0.53, p < 0.001), and CR to R-CHEMO2 (HR 0.22, 95% CI 0.11–0.44, p < 0.001) were associated with PFS2. Median OS2 was not reached and 5-year OS2 was 81% (95% CI 80–82). 27 patients died at the time of last follow up; 20 from lymphoma, and 7 from other causes. Elevated LDH (HR 3.22, 95% CI 1.42–7.28, p = 0.005), high FLIPI (HR 5.13, 95% CI 2.04–12.86, p < 0.001), ASCT (HR 0.19, 95% CI 0.06–0.64, p = 0.007) and CR to R-CHEMO2 (HR 0.31, 95% CI 0.11–0.89, p = 0.029) were associated with OS2. 53/56 patients with progression after R-CHEMO2 received 3rd line therapy, which was heterogeneous: 35 received R-CHEMO3, 3 ASCT, 9 allogeneic SCT, and many patients received novel/experimental agents. The median time to 3rd line therapy was 1.5 years (range 0.13–8.1). 5-year OS3 of 57% (95% CI 55–59) did not differ according to indolent vs. aggressive behavior (p = 0.306). Summary/Conclusion: Patients with relapsed FL treated with R-CHEMO1 can be successfully treated with R-CHEMO2 and achieve prolonged PFS2 and freedom from 3rd line treatment. Patients under the age of 60, those treated with ASCT, and those who achieve a CR have improved PFS2. Outcomes at progression after R-CHEMO2 are less favorable, highlighting the need for other therapies in these patients. These data may provide benchmarking for clinical trial development and regulatory purposes.
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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) | 0,001 | 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 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 ».