86: Long-Term Follow-Up of Autologous Stem Cell Transplant (ASCT) in Patients with Mantle Cell Lymphoma (MCL)
Bibliographic record
Abstract
Introduction: MCL is considered incurable with conventional therapy. ASCT has been shown to prolong progression free survival. However, reported median follow-up is generally short. We report a review of the outcome of patients (pts) with MCL who underwent ASCT at our institution with longer follow-up (f/u). Method: From May 1987 – Jul 2006, 47 pts underwent ASCT for advanced stage MCL, 43 of whom had adequate f/u data and were subsequently analyzed for outcome. Results: At ASCT, median age: 53 years (range 34–65), 36 males, CR: 21, PR: 22. 12 pts were transplanted beyond first CR or PR (>CR/PR1). Primary therapy: CHOP (n = 37; R-CHOP: 9) and other combination chemotherapy: 6. Salvage therapy in >CR/PR1: 7 had DHAP, 3 CHOP, 1 mini-BEAM and 1 ESHAP. 21 pts had rituximab before (11 with first line or salvage and 10 with mobilizing chemotherapy) and 11 had maintenance after ASCT. High dose regimen: CBV: 9, VP16/Melphalan/TBI 12Gy: 27 or VP16/Melphalan: 11. Stem cell source: peripheral blood: 40, bone marrow: 2 and mixed: 1. Progressive disease (PD) occurred in 21 pts; median time to progression post ASCT: 25 m. 32 pts remain alive (22 in CR, 10 have relapsed), while 11 pts have died of PD. No transplant related deaths. 4 pts developed secondary malignancies: 1 MDS, 1 skin (basal cell), 2 lung and 1 breast cancers. With a median f/u of 57 months from ASCT, median PFS was 42m while median OS has not been reached (5 year OS: 65%). Of pts who have not relapsed, 7 continue to be alive and disease free > 5 years after ASCT. Univariate analysis identified the use of rituximab before and/or after ASCT (p = 0.047) and ASCT in CR/PR1 (p = 0.001) as being statistically significant predictors of improved OS with only ASCT in CR/PR1 remained significant in multivariate analysis. For PFS, maintenance rituximab post-ASCT (p = 0.03) and ASCT in CR/PR1 (p = 0.01) were significant on univariate analysis with ASCT in CR/PR1 remaining significant in the multivariate model (median PFS of 12m in >CR/PR1 vs. 62m in CR/PR1, p = 0.008). Conclusion: ASCT can achieve prolonged remissions in MCL with some pts having remission duration of over 5 years. Pts transplanted in first remission appear to have superior PFS and OS compared to those transplanted in later stages. Seconds cancers may be a concern with longer follow-up. A significant number of pts relapse after ASCT, necessitating the exploration of more effective treatment strategies such as the incorporation of rituximab before and/or after ASCT.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".