Safety and Efficacy of Mini-CHOP-R Chemotherapy for Treatment of Diffuse Large B Cell Lymphoma in Very Elderly Patients: A Quality Assurance Study
Notice bibliographique
Résumé
Background: Diffuse Large B Cell Lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. Very elderly patients with DLBCL, defined as patients who are 80 years of age or older, have inferior outcomes related to co-morbid illness, poor performance status, and intolerance of full dose chemotherapy. In 2011, a phase II study of DLBCL in very elderly patients suggested a dose attenuated protocol of CHOP-R (mini-CHOP-R) reduced adverse effects while maintaining efficacy (Lancet Oncology 2011). Based on these results, the mini-CHOP-R protocol became the standard of care for very elderly patients at the London Regional Cancer Program (LRCP) in London, Ontario, Canada in November 2011. These patients had previously received either standard dose CHOP-R or a modified version in which the dose was reduced at the discretion of the treating clinician. Objective: This quality assurance study compares safety and efficacy outcomes among very elderly patients with DLBCL treated before and after adoption of the mini-CHOP-R treatment protocol. Methods: Outcomes of very elderly patients with DLBCL treated at LRCP with mini-CHOP-R between November 2011 - November 2014 were compared to the outcomes of patients treated in the 5 years preceding the treatment policy change. Results: Seventy-three patients were evaluated in this study. Thirty-seven patients (16M/21F; median age 83, range 80-93) treated with mini-CHOP-R comprised the study group, and thirty-six patients (16M/20F; median age 83, range 80-97) who received standard or 'clinician-modified' CHOP-R comprised the historical control group. The two groups differed in stage and ECOG status but were otherwise similar. Thirty-three (89%) study patients had advanced stage disease vs. 15 (42%) patients in the control group (p= 0.018). Thirty-three (89%) mini-CHOP-R patients had an ECOG > 1 compared to 13 (36%) controls (p=0.0013). Study patients received a median of 6 cycles of mini-CHOP-R compared to 4.28 cycles in the CHOP-R cohort (p=0.11). Granulocyte-colony stimulating factors were used as primary prophylaxis in the majority of patients in both cohorts. Chemotherapy side effects necessitated dose reductions in 6 (16%) mini-CHOP-R patients vs. 24 (67%) control patients. This was mainly due to the difference in febrile neutropenia, which complicated 4/178 mini-CHOP-R cycles (2%) compared to 16/181 CHOP-R cycles (9%). Cardiac complications were observed in 1 (3%) mini-CHOP-R patient, compared with 3 (8%) controls. Response rates of mini-CHOP-R treated patients compared favorably to controls, with overall response rates of 31/37 (84%) vs. 30/36 (83%), complete responses of 20 (54%) vs. 19 (53%), and partial responses of 11 (30%) vs. 11 (31%). Six patients in each group progressed on treatment. The 1-year overall survival and 1-year progression-free survival rates were 60% and 51% in mini-CHOP-R study group compared to 56% and 53% in control group. Conclusions: Results with mini-CHOP-R have been encouraging so far. Despite the more aggressive disease (higher stage, inferior ECOG) in mini-CHOP-R patients compared to controls treated with CHOP-R, similar response rates were achieved, with fewer adverse effects and better tolerability, which is of particular importance in very elderly patients. Longer follow up will be necessary to determine durability of responses. Disclosures No relevant conflicts of interest to declare.
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 | 0,009 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| 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 ».