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GRFS and CRFS in alternative donor hematopoietic cell transplantation for pediatric patients with acute leukemia

2019· article· en· W2942682252 on OpenAlexaff
Rohtesh S. Mehta, Shernan G. Holtan, Tao Wang, Michael Hemmer, Stephen R. Spellman, Mukta Arora, Daniel R. Couriel, Amin M. Alousi, Joseph Pidala, Hisham Abdel‐Azim, Ibrahim Ahmed, Mahmoud Aljurf, Medhat Askar, Jeffery J. Auletta, Vijaya Raj Bhatt, Christopher Bredeson, Saurabh Chhabra, Shahinaz M. Gadalla, James Gajewski, Robert Peter Gale, Usama Gergis, Peiman Hematti, Gerhard Hildebrandt, Yoshihiro Inamoto, Carrie L. Kitko, Pooja Khandelwal, Margaret L. MacMillan, Navneet S. Majhail, David I. Marks, Parinda A. Mehta, Taiga Nishihori, Richard F. Olsson, Attaphol Pawarode, Miguel Ángel Díaz, Tim Prestidge, Muna Qayed, Hemalatha G. Rangarajan, Olle Ringdén, Ayman Saad, Bipin N. Savani, Sachiko Seo, Ami J. Shah, Niketa C. Shah, Kirk R. Schultz, Melhem Solh, Thomas R. Spitzer, Jeff Szer, Takanori Teshima, Leo F. Verdonck, Kirsten M. Williams, Baldeep Wirk, John E. Wagner, Jean A. Yared, Daniel J. Weisdorf

Bibliographic record

VenueBlood Advances · 2019
Typearticle
Languageen
FieldMedicine
TopicHematopoietic Stem Cell Transplantation
Canadian institutionsBC Children's HospitalUniversity of British ColumbiaOttawa Hospital
FundersNational Institute of Allergy and Infectious DiseasesOffice of Naval ResearchPharmacyclicsKite PharmaHealth Resources and Services AdministrationNational Institutes of HealthSwedish Orphan BiovitrumJanssen Scientific AffairsMundipharma EDOAstellas PharmaAdaptive Biotechnologiesbluebird bioChimerixMedical College of WisconsinTakeda OncologyUniversity of MinnesotaKaryopharm TherapeuticsU.S. NavyCelgeneU.S. Department of DefenseSanofiU.S. Department of Health and Human ServicesAstellas Pharma USNational Center for Advancing Translational SciencesHistoGeneticsSanofi GenzymePatient-Centered Outcomes Research InstituteBristol-Myers SquibbMedacJazz PharmaceuticalsBe The Match FoundationSpectrum PharmaceuticalsNational Heart, Lung, and Blood InstituteNovartis Pharmaceuticals CorporationIncytePfizerAmgenAtara BiotherapeuticsNational Cancer InstituteGilead Sciences
KeywordsMedicineHazard ratioInternal medicineGastroenterologyTotal body irradiationBusulfanProportional hazards modelUmbilical cordConfidence intervalUnivariate analysisTransplantationMethotrexateHematopoietic stem cell transplantationCyclophosphamideMultivariate analysisImmunologyChemotherapy

Abstract

fetched live from OpenAlex

Abstract We report graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) (a composite end point of survival without grade III-IV acute GVHD [aGVHD], systemic therapy–requiring chronic GVHD [cGVHD], or relapse) and cGVHD-free relapse-free survival (CRFS) among pediatric patients with acute leukemia (n = 1613) who underwent transplantation with 1 antigen–mismatched (7/8) bone marrow (BM; n = 172) or umbilical cord blood (UCB; n = 1441). Multivariate analysis was performed using Cox proportional hazards models. To account for multiple testing, P < .01 for the donor/graft variable was considered statistically significant. Clinical characteristics were similar between UCB and 7/8 BM recipients, because most had acute lymphoblastic leukemia (62%), 64% received total body irradiation–based conditioning, and 60% received anti-thymocyte globulin or alemtuzumab. Methotrexate-based GVHD prophylaxis was more common with 7/8 BM (79%) than with UCB (15%), in which mycophenolate mofetil was commonly used. The univariate estimates of GRFS and CRFS were 22% (95% confidence interval [CI], 16-29) and 27% (95% CI, 20-34), respectively, with 7/8 BM and 33% (95% CI, 31-36) and 38% (95% CI, 35-40), respectively, with UCB (P < .001). In multivariate analysis, 7/8 BM vs UCB had similar GRFS (hazard ratio [HR], 1.12; 95% CI, 0.87-1.45; P = .39), CRFS (HR, 1.06; 95% CI, 0.82-1.38; P = .66), overall survival (HR, 1.07; 95% CI, 0.80-1.44; P = .66), and relapse (HR, 1.44; 95% CI, 1.03-2.02; P = .03). However, the 7/8 BM group had a significantly higher risk for grade III-IV aGVHD (HR, 1.70; 95% CI, 1.16-2.48; P = .006) compared with the UCB group. UCB and 7/8 BM groups had similar outcomes, as measured by GRFS and CRFS. However, given the higher risk for grade III-IV aGVHD, UCB might be preferred for patients lacking matched donors.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame distilled prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.

metaresearch head score (Codex)0.000
metaresearch head score (Gemma)0.000
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Observational · Consensus signal: Observational
GenreCandidate signal: Empirical · Consensus signal: Empirical
Teacher disagreement score0.110
Threshold uncertainty score0.564

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0000.000
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0000.000
Bibliometrics0.0000.000
Science and technology studies0.0000.000
Scholarly communication0.0000.000
Open science0.0000.000
Research integrity0.0000.000
Insufficient payload (model declined to judge)0.0000.000

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.

Opus teacher head0.005
GPT teacher head0.231
Teacher spread0.226 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

The models applied no category: nothing in the taxonomy fit this work.
Study designObservational
Domainnot available
GenreEmpirical

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".

Quick stats

Citations19
Published2019
Admission routes1
Has abstractyes

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