Single Institution Experience with Y-90 Ibritumomab Tiuxetan in the Treatment of Non-Hodgkin Lymphoma.
Bibliographic record
Abstract
Abstract Background: Radioimmunotherapy (RIT) is an effective treatment of Non-Hodgkin Lymphoma (NHL). Nonetheless, the use of RIT outside of clinical trials has been limited. We report here the experience in 25 patients treated with Y-90 ibritumomab tiuxetan off-protocol at a single institution. Patients and Methods: The charts of all patients treated with RIT between October, 2004 and May, 2006 were retrospectively reviewed in accordance with Good Clinical Practice guidelines. 19 patients were treated with RIT alone while 6 were treated with RIT in combination with high-dose chemotherapy and autologous hematopoietic stem cell transplant (HSCT). Dosimetry was not performed. Results: The median age of patients was 56 years (range 43–71 years). 13 of 25 had high-grade lymphoma (either transformed lymphoma or diffuse large B-cell lymphoma). The median IPI was 3. The median number of prior regimens was 3 (range 1–6). 6 patients had received fludarabine. 3 patients had undergone prior autologous HSCT and one had undergone allogeneic HSCT. The median time to platelet recovery >20 × 109/L was 35 days. One patient continues to have platelets <20 × 109/L 380 days post-RIT. The median time to recover platelets to >20 × 109/L was 72 among patients who had previously received fludarabine. Prior HSCT also appeared to be associated with prolonged thrombocytopenia. 7 patients remained neutropenic (ANC<0.5 × 109/L) for >30 days. One patient who had been treated with 4 lines of prior chemotherapy, including prolonged chlorambucil, developed acute myeloid leukemia at 6 months post-RIT. There have been 3 deaths to date, all due to disease progression at 1, 1, and 3 months post-RIT. The overall response rate in 21 of 25 patients was 84% with 9 patients achieving CR. With a median follow-up of 7 months, 5 patients have progressed. Conclusion: The use of off-protocol RIT in our institution was associated with similar response rates to those reported in patients treated on-protocol. Off concern, however, is the significant hematologic toxicity. There was an association between prior fludarabine and prolonged thrombocytopenia that has not been reported previously.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".