Comparison of Outcome Between Refractory/Relapsed De Novo Diffuse Large B-Cell and Transformed Lymphoma Using Related and Unrelated Allogeneic Hematopoietic SCT.
Notice bibliographique
Résumé
Abstract No data are available in the literature comparing the outcome of myeloablative allogeneic SCT (allo-SCT) for patients with refractory/relapsed de novo diffuse large B-cell lymphoma (DLBCL) and transformed lymphoma (TNHL). We hypothesized that outcomes would be similar for these 2 groups. In this single centre, population based study, a total of 71 such patients underwent allo-SCT (Oct 87 to Feb 07), 40 (56%) with TNHL and 31 (44%) with DLBCL. The 2- and 5-y OS for the whole group is 46% and 41% respectively, with median follow up for surviving pts of 67 months (range 13 – 183 m). The 1-y cumulative incidence (CI) of relapse and TRM for the whole group is 27% and 27% respectively. There were no significant differences between baseline characteristics for the two groups including: median age at diagnosis, stage, B-symptoms, IPI at diagnosis, number of prior therapies, CMV status of donor and recipient, donor type, level of HLA matching and conditioning regimen. Median age at SCT was 58 for TNHL compared to 50 for DLBCL (p<0.001) and more patients received prior rituximab therapy in the TNHL group (35%) compared to the DBCL group (13%), (p=0.03). Sixteen of 31 patients (53%) with DLBCL and 11 of 40 (27.5%) with TNHL are alive. Overall (OS) and event-free survival (EFS) are superior for the DLBCL group compared to the TNHL group mainly due to lower risk of therapy related mortality (TRM). OS for the DLBCL and TNHL groups at 2-y and 5-y are 55% vs 40% and 55% vs 28% respectively, (p=0.05). EFS for the DLBCL and TNHL groups at 2-y and 5-y are 52% vs 35% and 48% vs 27% respectively, (p=0.1). The CI of disease relapse post allogeneic stem cell transplantation for the DLBCL and TNHL groups are similar at 1-y: 32% vs 23% and at 5-y: 36% vs 36% respectively, (p=0.9). TRM is significantly lower for the DLBCL compared to the TNHL group with 1- and 5-year CI - TRM at 16% vs 35% and 16% vs 38% respectively, (p=0.04). Early complications post-allogeneic stem cell transplantation (Bearman toxicity criteria) were similar in both groups. The CI of grades II–IV acute graft host disease (aGvHD) is41% for DLBCL and 60% for TNHL (p=0.08). The cumulative incidence of aGvHD grades III/IV was lower in the DLBCL group (7%) compared to the TNHL group (25%), (p=0.049). The cumulative incidence of chronic GvHD (cGvHD) at 3 years was non-significantly higher in the DLBCL (48%) compared with the TNHL group (27%) (p=0.14). In summary, patients with refractory/relapsed de novo DLBCL treated with allogeneic SCT have better outcome compared to those with TNHL. There is a plateau on the survival curve at 50% for DLBC NHL, with good long-term disease-free survival. The same is not true with allo HSCT for T NHL, whereby a continuous pattern of failure is seen. Table: Basic characteristics of follicular and transformed groups. Parameter TNHL (%) DLBCL (%) P-Value *at diagnosis Patient number 40 (56) 31 (44) 0.342 (Ho: porp=0.5) Gender: Male/Female; Ratio 27/13 (67.5/32.5); 2/1 16/15 (52/48); 1:1 Chi-squared test: 0.174 Age (years): Median / Range 44 / 28 – 58 38 / 15 – 50 t test (equal means): <0.001 Donor Type: Sibling/ unrelated 25 / 15 (62.5 / 37.5) 25 / 6 (81 / 19) Chi-squared test: 0.10 Stage: * Fisher test: 0.296 I/II/III/VI 2/2/6/30 (5/5/15/75) 1/5/7/18 (3/16/23/58) IPI (number of factors)(0–1 vs 2–5) * Chi-squared test:0.4 0/1 5/13 (12.5/32.5) 3/8 (10/26) 2/3 15/5 (37.5/12.5) 7/9 (23/29) 4/5 2/0 (5/0) 4/0 (13/0) 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 | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 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 ».