EFFICIENCY AND SAFETY OF STEM CELL MOBILIZATION FOLLOWING GDP SALVAGE IN PATIENTS WITH RELAPSED OR REFRACTORY LYMPHOMA
Bibliographic record
Abstract
Background: High-dose chemotherapy and autologous stem cell transplant (ASCT) remains a key treatment strategy in patients (pts) with relapsed/refractory (R/R) aggressive lymphoma. After CCTG study LY.12 (Crump, et al, JCO 2014) established gemcitabine, dexamethasone and cisplatin (GDP) as standard salvage chemotherapy regimen at our centre, we replaced our previous mobilization strategy using cyclophosphamide + etoposide (CE) with PBSC collection using GDP. The aim of this study was to compare the efficiency, resource use and ASCT outcomes of PBSC mobilisation with GDP to CE. Methods: All pts undergoing PBSC mobilization following salvage GDP for R/R lymphoma from 1/2012 to 8/2018 were included in this analysis. CE comprised C 2 g/m2 d1, E 200mg/m2 d 1-3 + GCSF 10μg/kg d4-12, with apheresis planned d13. For collection following GDP, GCSF was added 10μg/kg d9-14, apheresis starting d15. Leukapheresis started when the blood CD34 count was >10 cells/μl (target >5 x 106 CD34 cells/kg). From May 2014 plerixafor 24 μg/kg was added to GCSF for slow or inadequate mobilization. Primary outcomes were PB CD34 count on planned day of apheresis and total CD34 cell yield. Secondary outcomes included number of apheresis days, febrile neutropenia after mobilisation, engraftment, hospital stay, transfusions, PFS and OS. Results: A total of 339 pts underwent PBSC mobilisation, 210 following GDP and 129 after CE. Pts in GDP group had more delays from planned to actual day of collection (mean 0.7 vs 0.4 days, p=0.006) and required more days of apheresis (mean, 1.7 vs 1.5 days, p = 0.001). The percentage of GDP pts collected on planned day of harvest and who required only one day of apheresis were 71% and 50%, versus 84% and 69% respectively after CE. In multi-variable analysis, CE led to both higher PB CD34 count on planned day of harvest and higher total CD34 yield (both p<0.001), despite a higher rate of plerixafor use in the GDP group (36/210 vs y/129). When considering a target CD34 yield ≥5x106/kg there was no difference between mobilization regimens (p=0.66). Similarly, on multivariable analysis, febrile neutropenia during mobilization, days to engraftment, ASCT admission duration and platelet transfusions did not differ between the two strategies; pts mobilized with CE required more RBC transfusion during ASCT (p=0.04). Prior BM involvement and plerixafor use were independent predictors for longer engraftment (p=0.013 and p=0.007 respectively), irrespective of regimen and CD34 yield. In multi-variable Cox analyses, disease status at time of ASCT was the main predictor of PFS and OS. Conclusions: CE+GCSF appears to be a more efficient mobilization method than GDP+GCSF with regard to number and timing of leukapheresis in pts undergoing GDP salvage for R/R lymphoma; however this did not translate to significant differences in engraftment or length of hospital admission. Keywords: autologous stem cell transplantation (ASCT); gemcitabine; salvage treatment.
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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 | 0.000 | 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".