A retrospective population-based study of long-term treatments and outcomes inwaldenstrom macroglobulinemia in Ontario, Canada
Notice bibliographique
Résumé
Abstract Introduction: Waldenstrom Macroglobulinemia (WM) is a rare B-cell malignancy characterized by periods of low burden disease not requiring treatment eventually leading to active disease requiring therapy. Treatment approaches have evolved over time including chemotherapy ± monoclonal antibodies such as rituximab and most recently targeted agents including Bruton Tyrosine Kinase Inhibitors. We sought to characterize treatments and real-world long-term outcomes in a contemporary cohort of Waldenstrom Macroglobulinemia/Lymphoplasmacytic Lymphoma patients. Methodology: This was a retrospective population-based study in Ontario, Canada using linked administrative databases. All eligible patients >18 years diagnosed from 2005 to 2023 identified within the Ontario Cancer Registry were included. All provincially funded treatment regimens were documented; however, treatments funded by compassionate access, private insurance or investigational regimens as part of clinical trials were not captured. In total, n=1,986 patients identified as having either Lymphoplasmacytic Lymphoma or Waldenstrom Macroglobulinemia were included in this study. We evaluated outcomes including types of treatment, time to second line therapy and overall survival using the Kaplan Meier method. Results: Out of the 1,986 patients with Waldenstrom Macroglobulinemia/Lymphoplasmacytic Lymphoma included in the cohort, the median age was 73 (IQR: 64-80) and 39% were female. Patients were followed for a median of 4 years (IQR: 2-8). In total, 55% of patients (n=1,093) received provincially funded treatment for Waldenstrom's during the follow-up period; median Kaplan Meier estimate of time from diagnosis to first-line treatment was 1.9 years. Of those who received frontline therapy, 52% of patients (n=569) went on to receive rituximab maintenance therapy and 23% of patients (n=250) went on to receive second-line treatment; median Kaplan Meier estimate of time to second line therapy was over 13 years. In total, 80 patients (4% of the overall cohort and 7% of those who received frontline therapy) received three or more lines of treatment. In total, 37% (n=727) of patients died within with the follow-up period, with median Kaplan Meier survival estimate of 9.9 years after diagnosis. The most common frontline treatment regimens (each +/- anti-CD20 antibody) were Bendamustine (60%), CVP (21%), Bruton Tyrosine Kinase inhibitor (5%), rituximab monotherapy (5%), Chlorambucil (4%) or CHOP (2%). Comparison of overall survival, time to second line therapy and depth of response based on IgM for different treatment regimens is under active investigation. Conclusion: We characterized real-world long-term outcomes in a large population-based cohort of Waldenstrom's patients. Newly diagnosed patients over the past two decades have received multiple frontline treatment regimens and overall have robust long-term survival outcomes.
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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 | 0,005 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| 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 ».