Salvage Therapy with Allogeneic Stem Cell Transplantation Results in Better Outcome for Patients with Relapsed/Refractory Follicular Lymphoma Compared to Those with Transformed Non-Hodgkin Lymphoma: A Population-Based Comparative Study.
Notice bibliographique
Résumé
Abstract We compared the outcome of patients who received myeloablative allogeneic stem cell transplantation for relapsed follicular and transformed non-Hodgkin lymphoma (1998– 2006). Data were prospectively entered into computerized Leukemia/BMT and BCCA databases. We hypothesized that outcome would be superior for patients proceding to SCT prior to transformation. This is a large, single-institution, population-based comparative cohort study. Forty consecutive patients (49%) have transformed or composite lymphoma and 42 (51%) follicular lymphoma. There were no significant differences between baseline characteristics at diagnosis for the 2 groups including median age, gender, stage, B symptoms, ECOG performance status, IPI, response to primary treatment or at stem cell transplant including age, number of prior therapies, conditioning regimen, prior rituximab therapy, donor type (sibling vs unrelated), or cytomegalovirus serology status of donor and recipient. Twenty eight of 42 patients (67%) with follicular lymphoma and 11 of 40 (28%) with transformed lymphoma are alive with median follow-up for the whole group at 26 months (range: 1–127 m). Overall (OS) and event-free survival (EFS) are superior for the follicular compared to the transformed lymphoma group mainly due to a lower relapse rate. The 2- and 5-year OS for the follicular and transformed groups are 71% vs 40% and 64% vs 28% respectively, (p=0.001). The 2- and 5-year EFS for the follicular and transformed groups are 71 vs 35% and 64 vs 27% respectively, (p<0.001). The cumulative incidence of disease relapse at 1- and 5-years post allogeneic stem cell transplantation for the follicular and transformed groups are 2% vs 23% and 2% vs 36% respectively, (p<0.001). Treatment related mortality (TRM) was comparable with 1- and 5-year cumulative incidence of TRM at 22 vs 35% and 34 vs 38% for the follicular and transformed groups respectively, (p=0.39). Early complications post-allogeneic stem cell transplantation (Bearman toxicity criteria) were similar in both groups. The risk of acute graft host disease (aGvHD) all grades was similar in both groups with a cumulative incidence of 68.8% and 60% at day 100 for the follicular and transformed groups respectively (p=0.40). The cumulative incidence of severe aGvHD grades III/IV was also similar in both groups, (p=0.32). However the cumulative incidence of chronic GvHD (cGvHD) at 2-years was significantly higher in the follicular (63.5%) compared to the transformed group (26.7%) (p=0.01). This may suggest that the lower relapse rate seen with follicular lymphoma is due to graft versus lymphoma effect associated with the higher risk of cGvHD observed in the follicular group. In summary, allogeneic stem cell transplantation results in good long term survival rates for patients with refractory and relapsed follicular lymphoma but poor outcome is observed for those proceding to allograft after transformation. Patients with high risk follicular lymphoma and those at high risk for transformation should be offered allogeneic stem cell transplantation ideally before transformation occurs. Table: Basic characteristics of follicular and transformed groups. Parameter TNHL (%) Follicular NHL (%) P-Value Number of patients 40 (49) 42 (51) 0.912 (Ho: porp=0.88) Gender: Male/Female; Ratio 27/13 (67.5/32.5); 2/1 23/19 (55/45); 1:1 Chi-squared test: 0.24 Age (years): Median / Range 44 / 28 – 58 45 / 20 – 61 t test (equal means): 0.20 Donor Type: Sibling/ unrelated 25 / 15 (62.5 / 37.5) 28 / 14 (81 / 19) Chi-squared test: 0.69 Stage: * Fisher test: 0.54 I/II/III/VI 2/2/6/30 (5/5/15/75) 1/6/7/27 (2/15/17/66) IPI (number of factors)(0–1 vs 2–5) * Fisher test: 0.47 0/1 5/13 (12.5/32.5) 6/16 (18/47) 2/3 15/5 (37.5/12.5) 9/3 (26/9) 4/5 2/0 (5/0) 0/0 (0/0) Figure Figure
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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 | 0,000 | 0,001 |
| 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) | 0,001 | 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 ».