Impact of Conditioning on the Outcome of Allografting in Myelofibrosis with Myeloid Metaplasia: Better Survival with Reduced Intensity Approach in Patients ≥50 Years.
Bibliographic record
Abstract
Abstract We analyzed the impact of intensity of conditioning therapy on the outcomes of allogeneic blood or marrow transplantation (BMT) in patients (pts) with myelofibrosis with myeloid metaplasia (MMM). The study included 46 consecutive patients treated at 7 transplant centers between 1998 and 2005. The indications for BMT were intermediate/high risk disease (n=41) or low risk disease with constitutional symptoms (n=5). Donors were matched sibling/family donor (n=25); mismatched family donor, 2; and unrelated, 19. Twenty-three pts received conventional myeloablative (MY) conditioning: Cy/TBI (n=22); Bu/Cy (n=1), and 23 received non-myeloablative (NMA) conditioning [fludarabine (Flu)/PO or IV Bu (n=16); Flu/TBI 200cGy (n=6); others(n=1)]. Median age at BMT of the MY and NMA group was 47 (31–60) and 54 (38–74) years, respectively. NMA group had a higher proportion of pts ≥50 years (74% vs 30%, p=0.003), a longer interval from diagnosis to BMT (p=0.05) and more transplants using blood stem cells (p=0.0002). At a median follow-up of 31 (1–89) months, 8 and 16 patients were alive in MY and NMA groups, respectively. The transplant related outcomes of the two groups are summarized in the table. Serial pre and post BMT bone marrow biopsy results were available in 24 patients. Median days to resolution of fibrosis were 167 and 363 in the MY and NMA groups (p=0.16). In a multivariate analysis, after adjusting for age the survival was better for pts ≥50 years treated with NMA approach (hazard ratio 2.98, 95% CI 1.09–8.12, p=0.03). In conclusion, both MY and NMA approaches have curative potential for pts with MMM. NMA approach is particularly promising in pts ≥50 years. Table: Comparison of BMT related outcomes for MY and NMA conditioning for MMM Outcomes MY Group (95% C.I.) NMA Group (95% C.I.) P value Neutrophil engraftment (days) 21 (13–46) 18 (1–30) 0.01 Cumulative incidence of graft failure (primary and secondary) at 2-years % 30 (16–58) 23 (10–50) 0.51 Median number of hospital days (Day 0 to +100) 41 (26–85) 27 (8–58) 0.0006 Cumulative incidence of acute GvHD grade II–IV (%) 78 (62–98) 18 (7–45) 0.0002 Cumulative incidence of chronic GVHD at 2-years % 94 (79–100) 45 (27–74) 0.0009 Cumulative incidence of TRM at 2-years % 43 (27–70) 27 (14–55) 0.08 Progression free survival at 2-years % 48 (27–66) 64 (40–80) 0.11 Overall survival at 2-years % 57 (34–74) 68 (45–83) 0.08
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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 | 0.000 | 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".