CLINICAL UTILITY OF INTERIM CT SCANS IN PATIENTS RECEIVING CHEMOIMMUNOTHERAPY FOR FIRST LINE TREATMENT OF FOLLICULAR LYMPHOMA
Notice bibliographique
Résumé
Interim imaging with computed tomography scanning (CT) has been performed midway through treatment during most clinical trials of chemoimmunotherapy in patients with follicular lymphoma (FL) receiving first line systemic therapy. Based on this, interim imaging is commonly performed, but there is little evidence of its utility in clinical practice. The objective of this study was to retrospectively review the outcomes of interim CTs (iCT) in adult patients with biopsy proven FL (grade 1-3a, 3b excluded) who met criteria for treatment and received first line therapy with rituximab with cyclophosphamide, vincristine and prednisone (RCVP) or bendamustine and rituximab (BR) at Princess Margaret Cancer Centre from January 1 2003- December 31 2018. Baseline patient characteristics and treatment were retrieved from a prospectively populated database, and results of interim and end of treatment CTs were evaluated from the electronic medical record. Disease response was assessed using Lugano response criteria as partial response (PR), complete response (CR), stable disease (SD) or progressive disease (PD). Descriptive statistics and Kaplan Meier Survival functions with a log rank test were used for analysis. The study was approved by the Princess Margaret Research Ethics Board. A total of 190 patients were identified: mean age at diagnosis 58.6 years (IQR 49.2-67.8), 78% with stage III/IV disease, 26.8% bulky (>10cm) and 41.1% FLIPI score >2. Patients received either 6-8 cycles of RCVP (n = 69, 36.3%) or 6 cycles of BR (n = 121, 63.7%) with a median follow up of 75 months (range 6.6-204.0 months). Most patients (n = 177,93.1%) had interim imaging done between the end of cycle 2 and prior to cycle 5, most commonly CT scan (n = 174,91.5%). Most iCTs showed a PR (n = 147, 77.4 %), with a minority showing a CR (n = 15, 7.9%) and SD (n = 8, 4.2 %). Seven patients (3.7%) had PD noted on iCT. Four patients had a second malignancy identified on repeat biopsy of lesions found on iCT (thymoma, poorly differentiated carcinoma, lung adenocarcinoma and spindle cell tumour), 2 of whom were symptomatic at the time of imaging. Of the 3 remaining patients, 2 were symptomatic at the time of iCT and only 1 had asymptomatic PD; all 3 had biopsies demonstrating transformation to diffuse large B cell lymphoma (DLBCL). The 3 year PFS of all patients was 85.29%. Patients with a PR on iCT had similar 3 year PFS compared to those with CR (86.25% vs 85.71%, p = .80) as well as overall survival (94.46% vs 92.31%, p = 0.58). Conclusion: iCT is not useful in identifying patients with asymptomatic early progression of FL during frontline treatment with BR or RCVP. The majority of patients receiving systemic treatment for FL with BR or RCVP have at least a PR on iCT, which is not associated with inferior PFS or OS compared to those with CR. Patients with symptomatic or asymptomatic PD during treatment warrant biopsy to identify histologic transformation or other malignancies. EA – previously submitted to ASCO 2021. The research was funded by: The Princess Margaret Cancer Foundation Keywords: Indolent non-Hodgkin lymphoma Conflicts of interests pertinent to the abstract S. Bhella Consultant or advisory role: Celgene R. Kridel Research funding: Gilead Sciences, Roche V. Kukreti Consultant or advisory role: Kirin Kyoto J. Kuruvilla Consultant or advisory role: Abbvie, BMS, Gilead, Karyopharm, Merck, Roche, Seattle Genetics Honoraria: Amgen, Antengene, Astra Zeneca, BMS, Gilead, Incyte, Janssen, Karyopharm, Merck, Novartis, Pfizer, Roche, Seattle Genetics, TG Therapeutics Research funding: Canadian Cancer Society, Leukemia and Lymphoma Society Canada, Princess Margaret Cancer Foundation, Janssen, Roche, Astra Zeneca Other remuneration: Lymphoma Canada (Chair) A. Prica Honoraria: Astra-Zeneca, Gilead M. Crump Honoraria: Kite/Gilead, Novartis, Servier Research funding: Roche, epizyme
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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 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 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.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».