99: Predictors of Outcome of Mantle Cell Lymphoma in Patients with Progressive Disease following Autologous Stem Cell Transplantation (ASCT)
Bibliographic record
Abstract
Introduction: Mantle Cell Lymphoma (MCL) is a subgroup of malignant lymphomas that is considered incurable with conventional therapy. While ASCT has improved progression free survival (PFS), relapse remains a major issue. For patients (pts) who relapse after ASCT, there is little information on the predictors of outcome and optimal treatment strategy. We reviewed pts with progressive disease following ASCT in an attempt to identify predictors of subsequent outcome. Method: We retrospectively reviewed our computerized database and charts of pts undergoing ASCT from May 1987 - Jul 2006. Of 47 pts, 21 relapsed after ASCT; 20 had adequate data on subsequent therapy and were analyzed for factors influencing progression free survival (PFS) and overall survival (OS) using Kaplan-Meier and Cox-Proportional Hazards analyses. Results: Pt characteristics: At relapse post-ASCT, median age was: 56 years (range 40–69). Stage 3 or 4: 16. High LDH: 8. Disease status of ASCT: CR1/PR1 = 9, >CR1/PR1 = 11. IPI scores: low (n = 9), low-intermediate (n = 8), high-intermediate (n = 2) and high (n = 1). FLIPI scores: low (n = 10), intermediate (n = 4) and high (n = 6). Seven had bone marrow involvement, 3 had involvement of peripheral blood and 5 had splenomegaly. Eighteen pts received subsequent treatment: R-FCM: 4, Rituximab: 1, Radiation alone: 3, other combination chemotherapy: 9 and 1 underwent reduced intensity allogeneic transplantation. Two pts were not fit to receive further treatment and had rapidly progressive disease (PD). Of the treated pts, 6 achieved CR (4 subsequently progressed), 5 PR and 7 had PD. Eleven pts remain alive (only 2 in CR) with PD accounting for all deaths. With a median follow-up of 31 months (m) post relapse for living pts, median PFS from the time of relapse post-ASCT was 5 m and OS was 34 m. No significant predictors of PFS could be identified. For OS, univariate analysis identified time to relapse (TTR; p = 0.011), performance status (PS; p = 0.010) and total IPI score (p = 0.041) as being statistically significant. Only TTR remained significant on the multivariate model. TTR less than 12 months portends a very poor outcome (2 year OS 0% compared to 62% form TTR >12 m; p < 0.001). Conclusion: Pts with MCL who relapse after ASCT do poorly, especially those relapsing within one year of ASCT. New therapeutic approaches incorporating maintenance therapy post-ASCT or the use of novel agents such as bortezomib or mTOR inhibitors should be explored in this group.
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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 | 0.000 | 0.002 |
| 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) | 0.002 | 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".