Management and Outcomes for Primary Mediastinal B-Cell Lymphoma Patients with Partial Metabolic Response
Notice bibliographique
Résumé
Background: The optimal management of patients with primary mediastinal B-cell lymphoma (PMBCL) who experience a partial metabolic response (PMR) on FDG-PET after initial systemic therapy is unclear. This study aimed to investigate different management strategies and outcomes for PMBCL patients who achieved PMR following primary systemic therapy, utilizing a single-center retrospective design. Methods: We reviewed the electronic medical records of 121 PMBCL patients who underwent post-chemotherapy PET scans at the Princess Margaret Cancer Center, Toronto, from January 2009 to September 2021. Using Modified Lugano criteria (2014), post-chemotherapy PET scan results were evaluated, with Deauville score (DS) 0-3 considered a complete metabolic response. Demographic, clinical, and imaging characteristics of the PMBCL population were analyzed. The Kaplan-Meier method was used to estimate progression-free survival (PFS), measured from the time of the post-systemic therapy PET. Results: A total of 121 patients with PMBCL underwent post-chemotherapy PET scans. Among them, 49 patients (40%) demonstrated incomplete metabolic response (DS4-5) Among these 49 patients, 12 showed primary refractory disease, while 37 demonstrated a partial metabolic response (PMR, DS4). The median age at diagnosis of the 37 patients with PMR was 30.8 years (range:18.4 - 52.8 years), and 20 (54%) were female. The median length of follow-up for these patients was 3.7 years (range: 0.4 to 9.2 years). Most PMR patients were stage I/II (26 patients, 70.3%), while the remaining were stage III (2 patients, 5.4%), or stage IV (8 patients, 21.6%), and 26 (70.3%) had a large mediastinal mass (maximum diameter exceeding 10cm). Initial systemic treatment was R-CHOP-21 (34 patients, 91.9%), R-CHOP combined with dose-adjusted R-EPOCH (2 patients, 5.4%), and dose-adjusted EPOCH (1 patient, 2.7%). Thirty one patients (83.8%) received 6 cycles. Following treatment strategies were employed to manage PMR: 1) radiation therapy (RT) only with or without biopsy in 30 patients (80.1%); 2) an observational approach (repeating PET scans without immediate treatment) in 3 patients (8.1%); 3) salvage chemotherapy in 3 patients (8.1%) and other approach in 1(2.7%) patient. The 2-year progression-free survival (PFS) rate for all patients with incomplete metabolic response (n=49) was 74.5% (95% CI = 62.5% to 88.9%). For patients with primary progression on post-chemotherapy PET scans the 2-year PFS (ie free of 2nd progression) was 40% (18.7% to 85.5%), while the 2-year PFS for patients with PMR was 85.4% (74.3% to 98.1%). PMR patients who underwent radiotherapy (RT) had the 2-year PFS rate of 92.7% (95% CI: 83.5% to 100.0%). No progression or relapsed occurred among the 3 patients with PMR who were managed with repeating PET scans without immediate further treatment. Conclusion: This study replicates prior work demonstrating a higher rate of incomplete metabolic response for PMBCL patients following R-CHOP-21 than typically reported for DLBCL. RT to persistent PET-avid sites is associated with excellent PFS. The favorable outcome of PMR patients without any additional treatment illustrates the non-trivial risk of false-positive PET scans following systemic therapy, and the need to identify criteria that can distinguish those who need additional treatment from those who can be safely observed.
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 | 0,000 | 0,002 |
| 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 ».