IMPACT OF DIFFERENT INDUCTION REGIMENS ON THE OUTCOME OF PRIMARY MEDIASTINAL B CELL LYMPHOMA IN THE PROSPECTIVE IELSG 37 TRIAL
Notice bibliographique
Résumé
Introduction: Primary mediastinal B-cell lymphoma (PMBCL) is characterized by poor prognosis if adequate responses are not rapidly achieved or if the disease recurs. Therefore, dose-intensive chemoimmunotherapy regimens are widely used but their superiority over the standard R-CHOP21 regimen has not been proven by randomized trials, furthermore they come with significant associated toxicities. Radiotherapy (RT) can consolidate responses after induction, but it may increase the risk of second malignancies and accelerate coronary heart disease. The IELSG37 trial was planned according to a non-inferiority design to demonstrate that RT may be unnecessary in patients achieving a metabolic complete remission. The primary-endpoint analysis per arm will be reported when >80% will have a minimum post-treatment follow-up of 30 months. Herein we present a preliminary analysis of the outcomes after different induction regimens in the whole study population. Methods: Patients with newly diagnosed PMBCL were eligible. Initial therapy was to be based on a combination containing rituximab and anthracyclines. The regimen was chosen according to local practice. Upon central review of post-induction PET scans, responding patients were randomized to observation versus consolidative RT. Responses were defined according to the Lugano classification using the Deauville 5-point scale (DS). Patients progressing during induction did not have central PET review and in the present analysis were assigned DS score 5. Results: 545 patients (209 men, 336 women) were enrolled and treated with R-V/MACOP-B (n = 168, 31%), R-CHOP14 (n = 146, 27%), R-CHOP21 (n = 98, 18%), DA-EPOCH-R (n = 88, 16%), R-megaCHOP (n = 19, 3%), other dose-intensive regimen (n = 26, 5%). At a median follow up of 3 years, approx. 95% of patients are alive. The rate of complete metabolic responses (CR, defined by DS 1-3) did not differ significantly across regimens, however an unbalanced distribution of DS score was evident, apparently due to the rate of patients with a probable induction failure (DS5) more than 2 times higher for CHOP21 in comparison to the other regimens. At preliminary univariate analysis there was no significant association of advanced stage, older age, extranodal infiltration, poor performance status, bulky disease, unfavorable international prognostic index (IPI) and larger metabolic tumor volume (MTV) with the use of CHOP21. Patients receiving DA-EPOCH-R were somehow younger than the rest. The research was funded by: IELSG37 was supported in part by grants from Swiss National Science Foundation (SNSF) – Project 32003B_146931,Krebsforschung Schweiz – Projec KFS-2852-08-2011 and Cancer Research UK (C30423/A16247)The enrolment of Swiss patients was supported by the Swiss Group for Clinical Cancer Research (SAKK) Keywords: Chemotherapy Combination, Therapies Immunotherapy No conflicts of interests pertinent to the abstract.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 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) | 0,000 | 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 tête enseignante, pas un consensus.
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