Autologous Stem Cell Transplantion for Adolescents and Young Adults with Relapsed and Refractory Hodgkin Lymphoma
Bibliographic record
Abstract
Abstract Abstract 2402 Adolescents and young adults with Hodgkin lymphoma (HL) represent a unique patient population, facing cancer and the toxicities of therapy during an important, transformative period of their lives. The long term outcomes of AYA undergoing intensive chemotherapy and autologous stem cell transplantation (ASCT), both medical and psychosocial, have not been well studied. We assessed the outcome of AYAs undergoing ASCT to define the results of treatment, and assemble a cohort in which we can evaluate the effect of treatment for relapsed disease on personal developmental and psychological outcomes. Between 1988 and 2009, 181 AYAs (median age 24, range 15–30y) with relapsed or refractory HL received salvage therapy followed by ASCT at Princess Margaret Hospital (PMH) and the Hospital For Sick Children (HSC). Patient characteristics: M:F 94:87; advanced stage (IIB-IV) at diagnosis 84%; first progression or relapse: 90%. All patients had complete or partial response to 2–3 cycles salvage chemotherapy (platinum-base, mini-BEAM or ifosfamide-vinorelbine), and underwent bone marrow harvest (n=83) or stem cell mobilization with chemotherapy and filgrastim (n=98). Intensive therapy: etoposide + melphalan (PMH) or cyclophosphamide, carmustine + etoposide (HSC). Patients with disease bulk >5cm at relapse received post-ASCT involved field radiation if tissue tolerance allowed. Results: After a median follow-up of surviving patients of 4 years (maximum 16 years), of 181 pts, there have been 105 events for progression-free survival (PFS) and 81 deaths. PFS at 5 years is 41% +/−4% (+/− standard error) and at 10 years is 36% +/−4% (median 1.6 years). Overall survival is 52% +/−5% at 5 years and 39% +/− 5% at 10 years(median 5.6 years). There have been no HL relapses beyond 39 months post-ASCT. Twenty patients (11%) died from treatment related-toxicity (10), second malignancies (5 AML, 2 NHL, 1 lung cancer) or unknown causes (2). Nine patients received an allogeneic stem cell transplant for relapse; 8 have died from progressive HL or treatment-related toxicity and one is alive in relapse. Conclusions: While highlighting the clear need for improved strategies for disease control for AYAs undergoing ASCT, this analysis has provided a cohort of patients in which to evaluate the long-term impact of intensive therapy on personal and social adjustment, and to identify opportunities for psychosocial intervention and health promotion. Disclosures: Kuruvilla: Hoffman LaRoche: Honoraria, Research Funding; Celgene: Research Funding; Amgen: Honoraria; Otsuka: Honoraria; Genzyme: Honoraria. Kukreti: Celgene: Honoraria.
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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 | 0.000 |
| 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".