Survival Improvements Following Myeloablative Allogeneic Hematopoietic Cell Transplantation For Acute Lymphoblastic Leukemia In Adolescents and Young Adults Have Been Comparable To Younger Children: A Study From The Cibmtr
Notice bibliographique
Résumé
Abstract Adolescents and young adults (AYAs) with cancer have not experienced survival improvements over time to the same extent as younger and older patients. Studies in acute lymphoblastic leukemia (ALL) have identified differences in chemotherapy treatment approaches, adherence and possibly outcomes for AYAs treated in pediatric vs. adult settings. To determine if these same issues are operative in ALL patients treated with hematopoietic cell transplantation (HCT), we compared outcomes among 2730 patients including 1008 children (<15 years), 1244 AYAs (15-40 years) and 478 older adults (> 40 years) receiving myeloablative allogeneic HCT for ALL at US centers over three time periods (1990-1995, 1996-2001, and 2002-2007). All patients were in first or second complete remission at HCT; Ph+ patients were included; umbilical cord blood transplant recipients were excluded. The proportions of patients receiving peripheral blood transplants and receiving HCT using well-matched unrelated donors increased over time in all three age groups. From 1996-2001 to 2002-2007, transplant volume increased by 7% in children, 50% in AYAs, and 180% in older adults. Our analysis demonstrated that 5-year overall survival varied inversely with age group, but survival for AYAs over time improved at rates comparable to survival in children (Figure). Multivariate analyses adjusting for important patient and disease characteristics confirmed that older age was associated with poorer survival (hazard ratio 2.2 for older adults and 1.7 for AYA vs. children, P<0.001); however, no significant interactions were observed between age and time period confirming that changes in survival rates over time were similar between the groups even after statistical adjustment for other factors. Similar findings were observed for transplant-related mortality (TRM) and relapse. Transplantation techniques and outcomes were also explored for a subset of 131 AYAs (ages 15-25) transplanted at 46 pediatric or 92 adult centers. Although limited by small numbers, univariate analyses did not show differences in probabilities of overall survival, TRM, or relapse by center type. Patients transplanted at pediatric centers had a longer time from diagnosis to transplant than patients transplanted at adult centers (p=0.024), and were more likely to receive bone marrow vs. peripheral blood stem cell graft (p<0.001). Conditioning regimens (p=0.04) and GVHD prophylaxis (p<0.01) also differed. Taken together, these findings suggest that, in contrast to what has been observed for other cancers over time, survival following myeloablative allogeneic HCT for AYA’s has improved at a rate comparable to other age groups. There appear to be differences in transplant timing and techniques for AYAs depending on whether treatment occurs in a pediatric or adult center but transplant outcomes did not significantly differ, in contrast to survival differences reported in the non-transplant setting. In summary, AYAs are experiencing improvements comparable with younger children, and appear to have similar outcomes whether transplanted at pediatric or adult centers.Figure5-year adjusted overall survival probabilities for the three age-groups and time periods. Boxes represent estimates (center lines) and 95% confidence intervals.Figure. 5-year adjusted overall survival probabilities for the three age-groups and time periods. Boxes represent estimates (center lines) and 95% confidence intervals. 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 | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| 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 ».