Developement of chronic GvH is the strongest predictor of survival in patients with poor-risk AML in remission after related or unrelated SCT
Bibliographic record
Abstract
High risk AML by clinical criteria, defined as relapsed or refractory disease, primary induction-therapy failure, secondary AML or advanced disease beyond 1st CR has a dismal outcome with all current therapies. We analysed the influence of transplant-related factors and GvHD on the outcome of adult pts with HR-AML who underwent an allogeneic SCT in the Alberta Transplant Program. Patients and methods: 105 adult pt median age 42, range 20 to 65y were transplanted between 5/88 and 7/02. 71 pt received SCT from related, 34 from matched unrelated donors. Indications for allo-SCT were: 71 AML, 24 in 2nd CR, 18 refractory relapse, 15 primary induction failure and 14 untreated relapse. 34 pt had secondary AML, either untreated (N=26), refractory (N=5) or relapsed (N=3). Conditioning-regimen used were: BuCy N=43 (6 pt with ATG), CyTBI N=17 (5 pt with ATG), FluBuATG N=34, VP16/TBI, N=8, other N=3. 62 pt received ATG (Sangstat, Fresno, USA) and 31 pt TBI. Cytogenetic results were available for 23 adult pt at relapse or pre-BMT and for 25 pt at initial diagnosis. Of these 3 were favorable (inv16, t8/21), 6 were normal karyotype, and 8 other single translocations, and 29 were either complex abnormal karyotype or high risk chromosomal aberrations (del 5q-, del7). 3y OAS survival for all adult pt was 28% (95% CI: 20.03–37.54%). No significant differences in survival were found for age-groups, cytogenetic risk-factors, MDS/AML vs AML, presence of aGvH >I°. A trend for improved survival was found for pt receiving TBI-containing regimen when compared to BuCY (p=0.064). The use of ATG in conditioning did not improve 100 d-OAS (no ATG 68.%, vs ATG 73%). Occurrence of cGvH resulted in a highly significant survival difference in favor of pts with cGvH with a median survival of 760 vs 230d (p=0.002, HR 2.3) and a 3y OAS of 47 vs 18% (p<0.01%). Chemotherapy-intensity or donor-type did not significantly influence outcome in this poor-risk cohort. The only factor with highly significant effect on survival (p=0.003) was the presence of chronic GvH suggesting a graft vs leukemia effect requiring clinically evident GvH. The beneficial effect of ATG on early mortality that has been shown in lower-risk pt-groups was not reproducible in this cohort possibly due to the high early relapse rate (data not shown).
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| 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) | 0.002 | 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".