Outcome of Patients with Chemotherapy Refractory and Early Progressive Diffuse Large B Cell Lymphoma After R-CHOP Treatment
Bibliographic record
Abstract
Abstract Abstract 1751 Background: The addition of rituximab to CHOP (R-CHOP) has markedly improved the progression-free and overall survival of patients (pts) with diffuse large B cell lymphoma (DLBCL). Nevertheless, 9.5% of pts harbor lymphoma that is refractory to R-CHOP (Feugier et al) and 18–27% experience relapse after initial response (GELA and MINT trial). Aim: Assess outcome of pts with primary refractory and early relapsing DLBCL (within 3 months of CR/PR post completion of R-CHOP treatment). Patients and Methods: The BCCA Lymphoid Cancer Database identified 1126 pts diagnosed with DLBCL between December 2000 and September 2009. All ages and stages were included and primary treatment was R-CHOP in all pts. Results: 166 pts(15%) had primary refractory or early relapsing disease, of which 93 were age >70 y and too frail to have received > 2 cycles of R-CHOP. Of the remaining 73 pts, 33 (45%) had primary refractory lymphoma and 40 (55 %) relapsed within 3 months of achieving a CR/PR. Pt characteristics (n=73): median age 57 y; 68% male; stage I (4 %), II (16 %), III (19 %), IV (60 %); PS 0,1 (41 %) PS 2–4 (59 %); LDH elevated (58 %); IPI 0 (1 %), 1 (15 %), 2 (15 %), 3 (30 %), 4 (35 %), 5 (2 %). There were no differences in the clinical characteristics of pts with primary refractory versus early relapsing disease. Of the 73 pts, 37 (50%) were without serious co-morbidity and were able to be treated with a curative intent that included multi-agent salvage chemotherapy with a plan to proceed to high-dose tx and autologous stem cell transplantation (ASCT), whereas 36 pts had palliative tx or comfort care only. 10 pts did undergo ASCT (3 primary refractory, 7 early relapsers). The median overall survival for the 73 pts was 10 months with only 6 pts alive without evidence of disease (range 14–106 months). 5 of these 6 pts had relapsed early after initial CR/PR, while only 1 patient had primary refractory disease. 3 of these 6 pts had salvage treatment without ASCT and 3 with ASCT. Conclusion: Chemotherapy-refractory or early relapsed disease after R-CHOP has a very poor outcome with only anecdotal survivors independent of the intended treatment approach. Biologic workup of this group of patients is urgently needed with the intention of defining the molecular underpinnings of treatment resistance. Disclosures: Savage: Roche: Honoraria. Sehn:Roche: Honoraria, Research Funding.
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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 | 0.001 |
| 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 | 0.001 | 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".