OUTCOME OF PRIMARY MEDIASTINAL LARGE B‐CELL LYMPHOMA IN THE RITUXIMAB ERA: IMPACT OF A PET‐GUIDED APPROACH
Bibliographic record
Abstract
Background: Primary mediastinal large B-cell lymphoma (PMBCL) is a rare subtype of lymphoma which typically presents in females with a bulky anterior mediastinal mass. Patients (pts) are treated with chemoimmunotherapy ± consolidative radiotherapy (CRT). Herein, we reviewed outcomes of PMBCL pts treated at BC Cancer in the rituximab era and the impact of a PET-adapted approach. Methods: The BC Cancer Lymphoid Cancer Database was used to identify pts >16 years (y) of age with newly diagnosed PMBCL based on the WHO classification who were treated with chemotherapy + rituximab. Prior to the availability of FDG-PET scan at end of treatment (EOT) in July 2005, all pts were recommended to receive R-CHOP and CRT (RT era, n=50). Since the availability of an EOT PET (PET era, n=109), only pts with a positive EOT PET (PETpos) were recommended to have CRT. Before 2014, PET scans were interpreted based on the International Harmonization Project (IHP) and after 2014 the Deauville (D) criteria (D1-3, DX = PETneg). IHP era PET scans were retrospectively reclassified using D criteria. Results: 159 pts with PMBCL were identified with a median follow up of 7.9 y (range 0.7 – 16.7 y) and the following characteristics: median age 36 y (range 19-84); 57% female; 70% bulky >10cm; 40% pleural/pericardial effusion; 37% extranodal sites >1; 43% B symptoms; 72% elevated LDH; 63% stage I/II. Pts received R-CHOP (n=149), R-CHOP/R-ICE (n=8) or DAEPOCH-R (n=2). 70 pts (44%) received CRT, 78% (n=39) in the RT era (2001-2005) and 28% (n=31) in the PET era (>2005). The 5y time to progression (TTP) and overall survival (OS) for the entire cohort were 80% and 89%, respectively. In a treatment era comparison, there was no difference in TTP (78% vs 81%, P=0.74) and OS (86% vs 91%, P=0.26) for pts treated in the RT vs PET era, respectively, with only one pt in the PET era not having a PET scan due to disease progression. 113 pts had an EOT PET which included 10 pts who had a self-pay PET: PETneg n= 71 (63%), of which 1% (n=1) received CRT; PETpos n=42(37%), of which 79% (n=33) received CRT. For all 113 pts treated with a PET guided approach, the 5 y TTP and OS were 83% and 94% respectively. For PETneg and PETpos cases, the 5 y TTP were 88% vs 74% (P=0.03) and 5 y OS were 97% vs 88% (P=0.78), respectively. All centrally performed PET scans pre-2014 (n=59) were reassigned by D criteria for a total of 103 D assigned cases; 71% PETneg; 29% PETpos. The 5 y TTP and OS for PETneg by D were 90% and 97%, respectively. For PETpos cases, outcomes were inferior for D5 (n=12) vs D4 (n=18): 5y TTP 33% vs 94% (P<0.0001); 5 y OS 67% vs 100% (P=0.002). Keywords: positron emission tomography (PET); primary mediastinal large B-cell lymphoma (PMLBCL); R-CHOP. Disclosures: Villa, D: Consultant Advisory Role: Roche, Lundbeck, Celgene, Abbvie, Seattle Genetics, Janssen, AstraZeneca, Gilead, Nanostring. Gerrie, A: Consultant Advisory Role: Janssen, AbbVie, Novartis; Research Funding: Roche, Lundbeck, Janssen. Scott, D: Consultant Advisory Role: Celgene and Janssen; Research Funding: Janssen, Roche/Genentech and NanoString. Freeman, C: Consultant Advisory Role: Celgene, Janssen, Amgen, Seattle genetics, Abbvie; Research Funding: Roche/Genentech. Pickles, T: Consultant Advisory Role: Sanofi, Astellas, Servier, Abbvie, Bayer, Ferring. Connors, J: Research Funding: Amgen, Bayer, Bristol-Myers Squibb (Inst), Cephalon (Inst), Genentech/Roche (Inst), Janssen Oncology (Inst), Lilly (Inst), Merck (Inst), NanoString Technologies (Inst), Roche, Seattle Genetics, Takeda. Sehn, L: Consultant Advisory Role: Roche/Genentech, Abbvie, Amgen, Apobiologix, Astra Zeneca, Acerta, Celgene, Gilead, Janssen, Kite, Karyopharm, Lundbeck, Merck, Morphosys, Seattle Genetics, Teva, Takeda, TG Therapeutics; Research Funding: Roche/Genentech. Savage, K: Consultant Advisory Role: BMS, Merck, SeaGen, Verastem; Honoraria: Takeda; Research Funding: Roche.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot 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.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 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) | 0.000 | 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 teacher head, 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".