Outcome Among Adolescents and Young Adults with Mature B-Cell Non Hodgkin Lymphoma at Pediatric Versus Adult Centers: A Population-Based Study Using the IMPACT Cohort
Notice bibliographique
Résumé
Background: Disparities in survival between adolescents and young adults (AYA) treated for acute lymphoblastic leukemia in pediatric versus adult centers are well documented. Whether similar disparities exist among AYA with mature B-cell non-Hodgkin lymphoma (B-NHL) is unknown, despite substantial differences between pediatric and adult treatment protocols. We compared outcomes among AYA with B-NHL by locus of care (LOC; pediatric versus adult) using a population-based clinical AYA database. We also assessed whether socioeconomic status or geographic area impacted outcome in this population. Methods: The IMPACT cohort comprises all Ontario, Canada AYA aged 15-21 years diagnosed with one of six common cancers (including NHL) between 1992-2012. Detailed demographic, disease (histology, stage), treatment, and outcome data were collected through chart abstraction and validated by content experts. Postal code at diagnosis allowed determination of neighbourhood income quintile and rural residence. Linkage to population-based health administrative data identified additional events (second cancers, relapse, death). Event-free (EFS) and overall survival (OS) were determined using Kaplan-Meier methods. The impact of LOC on EFS and OS was determined using multivariable Cox proportional hazard models, adjusted for demographics and disease-related variables. Results: Among 176 AYA with B-NHL, 62 (35.2%) received therapy at a pediatric center. Pediatric center AYA were more likely to have Burkitt lymphoma (BL) than diffuse large B-cell lymphoma (DLBCL) as compared to adult center AYA [26/62 (41.9%) vs. 21/114 (18.4%); p<0.001], and more likely to have advanced stage (i.e. Stage III/IV) disease [38/62 (61.3%) vs. 46/114 (40.4%); p=0.006]. The 5-year EFS and OS (with standard errors) for the whole cohort were 72.2%±3.4% and 76.1%±3.2%. Both EFS and OS were superior among pediatric center patients (EFS 82.2%±4.9% vs. 66.7%±4.4%; p=0.02), (OS 85.5%±4.5% vs. 71.1%±4.3%; p=0.03). When stratified by histology (BL vs. DLBCL), the EFS and OS were similar. However, the superior outcome of pediatric center AYA retained statistical significance only among those with DLBCL (Table 1). Adjusted for histology (BL vs. DLBCL), stage, and time period of diagnosis, adult center AYA had inferior EFS [hazard ratio (HR) 2.4, 95% confidence interval (95CI) 1.1-4.9, p=0.02] and OS (HR 2.5, CI 1.1-5.7, p=0.03). Neither neighbourhood income quintile nor rural residence was associated with EFS or OS. Conclusions: In this population-based cohort, AYA with B-NHL treated at pediatric centers experienced substantially superior EFS and OS compared to those treated at adult centers, even accounting for disease characteristics. In subgroup analyses, this difference retained statistical significance among patients with DLBCL but not among patients with BL, though the latter analyses were limited by small sample sizes. Future analyses will analyze whether patterns of treatment failure and late effects vary by locus of care. Further confirmatory studies are warranted, as are studies to determine the relative contribution of pediatric protocols versus other components of care. Our results nonetheless suggest that similar to AYA with acute lymphoblastic leukemia, AYA with B-NHL may benefit from being treated in pediatric centers with pediatric protocols. Disclosures Baxter: Servier: Membership on an entity's Board of Directors or advisory committees.
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 | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| 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 ».