Risks and Benefits of Rituximab Maintenance in Elderly Patients with Advanced Follicular Lymphoma
Bibliographic record
Abstract
Abstract Introduction: Based on the PRIMA trial (Lancet 2010; 377: 42-51), rituximab maintenance following induction rituximab-based chemotherapy is the standard of care in patients with advanced follicular lymphoma (FL) because it extended the 3-year progression free survival (PFS) from 58% to 75%, with a low rate of infection (<5%). However, this study was conducted in young patients (median age 57 years old) and the benefits and risks of the maintenance are unknown in elderly patients. Methods: We reviewed the clinical characteristics, outcome and complications of 62 advanced FL patients selected based on having successfully completed induction chemotherapy and initiated maintenance rituximab at the Jewish General Hospital between 2007 and 2014. The age cut off of ≥75 years old at the time of treatment was defined as "elderly". We compared characteristics of the two groups using the χ2 test and calculated PFS using the Kaplan-Meier method and log-rank test. Results: In total, 9/62 (15%) patients were "elderly" and 53/62 (85%) were "young", with median ages of 79 (75-87) and 55 (30-74) years old, respectively. Elderly patients had more adverse prognostic features compared to younger patients: B symptoms (4/9 vs 7/53, p=0.023), elevated lactate dehydrogenase (5/9 vs 9/51, p=0.013), lower hemoglobin (5/9 vs 3/52, p<0.001) and poor performance status (3/9 vs 1/53, p<0.001). The mean PFS was lower in elderly patients (25 months vs 65 months, p=0.05). The 3-year PFS in the young group was 80%. Toxicities were higher in the elderly group: grade 3-4 neutropenia (3/9 vs 5/53, p=0.05) and infections (5/9 vs 13/52, p=0.063). Conclusion: Elderly patients had more adverse prognostic factors and a significantly inferior PFS with rituximab maintenance compared to younger patients. The rates of infections were higher than those reported in the PRIMA trial. Maintenance rituximab may not benefit elderly patients with advanced FL. Disclosures No relevant conflicts of interest to declare.
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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 | 0.001 | 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) | 0.000 | 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 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".