296 | LIMITED STAGE DIFFUSE LARGE B CELL LYMPHOMA IN THE MODERN ERA: REAL‐WORLD OUTCOMES IN AN INTERNATIONAL STUDY OF OVER ONE THOUSAND PATIENTS
Notice bibliographique
Résumé
Z. Loh, H. Johns, A. Khurana, J. Paludo, R. Puckrin, D. Stephens, J. W. Friedberg, G. Hapgood, M. Bishton, M. Saleh, C. Fletcher, D. Villa, L. H. Sehn, A. Ravindra, U. Farooq, A. Danilov, S. Walker, K. Lewis, L. Churilov, C. Y. Cheah, and E. A. Hawkes equally contributing author. Introduction: Diffuse large B-cell lymphoma presents as limited stage disease (LSDLBCL) in 30% of patients (pts). LSDLBCL has distinct biology and outcomes, compared to advanced stage. We report clinical features, treatment and outcomes from a large, international LSDLBCL cohort. Methods: Our multicentre retrospective study enrolled adult pts from 4 countries from Jan 2013-July 2019, with PET-staged I-II DLBCL. Analysis was restricted to pts treated with curative intent RCHOP chemotherapy +/− radiotherapy (RT). Time to event variables were estimated using Kaplan-Meier methods. Multivariable Cox proportional hazards regression model was performed and adjusted for age, sex, ECOG, stage, LDH, extranodal disease, & bulk ≥ 7.5 cm. Results: 1058 pts were identified with a median follow up of 62 months (range 2–187). Characteristics were as follows; median age 63y (range 18–91), 55% male, 89% ECOG 0–1, Stage I 54%, B symptoms in 18%, elevated LDH 30%, bulk ≥ 7.5 cm 24%, extranodal involvement 53%. Stage modified IPI (smIPI) was: 0 in 18%, 1 in 38%, 2 in 30%, 3–4 in 14%. Overall response (ORR) was 96% (CR 91%). 5yr PFS & OS was 79% (95% CI: 77–82) and 85% (95% CI: 83–87) respectively. Median PFS and OS was 13.1yrs (12.4-NR) and 14.6yrs (12.9-NR). 11% had a progression event (median time to progression 14 m, range 1.4–125); 62% occurred at 0–2y, 22% at 3–5y, & 16% at 5–10y. 179 pts died; 67 due to lymphoma, 26 due to infections and 24 due to other cancers. On multivariable analysis, age > 60 (HR2.9, 95% CI: 1.7–4.8), ECOG > 2 (HR2.4 (1.4–4.2)) and stage II disease (HR1.9 (1.2–2.9)) were significantly associated with inferior OS. The presence of extranodal disease was significantly associated with inferior PFS (HR1.5 (1.1–2.1)), along with age > 60 (HR1.5 (1.0–2.2)), ECOG > 2 (HR2.0 (1.2–3.2)) and stage II disease (HR1.8 (1.3–2.7)). 5y PFS for smIPI score 0–1, 2 and 3–4 was 84% (95% CI: 81–87), 80% (74–84) & 63% (54–71) respectively. PFS and OS were similar with RCHOPx4, RCHOPx3-4+RT, RCHOPx6-8 and RCHOPx6-8+RT (PFS p = 0.462; OS p = 0.380) (Figure 1). In pts aged 18–60, with ECOG 0–1, normal LDH and bulk < 7.5 cm (n = 194), 5y PFS and OS was 89% (83–93) and 95% (90–98); similar to the 5y PFS and OS of 94% (91–97) and 97%–98% (94–100) in the German FLYER trial (Poeschel Lancet 2019). Conclusion: LSDLBCL outcomes in our large cohort are similar between standard treatment groups, and to that of recent landmark clinical trials. A persistent pattern of relapse was observed, contrasting with the typical outcomes seen in advanced-stage DLBCL. Future research efforts should aim to refine risk stratification to improve prognostic accuracy and optimize adaptive management approaches. Keywords: Non-Hodgkin; Aggressive B-cell non-Hodgkin lymphoma Potential sources of conflict of interest: J. Paludo Honoraria: AbbVie (to institution) Other remuneration: Research funding (to institution): Karyopharm, Biofourmis, AstraZeneca R. Puckrin Honoraria: Abbvie, Astrazeneca, Beigene, Eli Lilly, Seagen, Incyte, Kite, Janssen, Roche M. Bishton Consultant or advisory role: Incyte, Roche, Lilly, AbbVie Honoraria: Roche, Takeda, Celltrion, Kite/Gilead, Lilly, Abbvie, Recordati Other remuneration: Research funding Roche and Takeda U. Farooq Consultant or advisory role: Kite, Morphosys E. A. Hawkes Consultant or advisory role: Roche*, Merck Sharpe & Dohme*, Astra Zeneca*, Gilead, Antengene, Novartis, Regeneron, Janssen, Specialised Therapeutics, Sobi . Educational grants: Astra Zeneca Other remuneration: Research funding (paid to institution): Roche, Bristol Myers Squibb, Merck KgA, Astra Zeneca, TG therapeutics and Merck A. Barraclough Honoraria: Gilead, Roche, Novartis, Beigene Educational grants: AstraZeneca
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 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) | 0,001 | 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.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».