IMPACT OF DIFFERENT INDUCTION REGIMENS ON THE OUTCOME OF PRIMARY MEDIASTINAL B CELL LYMPHOMA IN THE PROSPECTIVE IELSG 37 TRIAL
Bibliographic record
Abstract
Introduction: Primary mediastinal B-cell lymphoma (PMBCL) is characterized by poor prognosis if adequate responses are not rapidly achieved or if the disease recurs. Therefore, dose-intensive chemoimmunotherapy regimens are widely used but their superiority over the standard R-CHOP21 regimen has not been proven by randomized trials, furthermore they come with significant associated toxicities. Radiotherapy (RT) can consolidate responses after induction, but it may increase the risk of second malignancies and accelerate coronary heart disease. The IELSG37 trial was planned according to a non-inferiority design to demonstrate that RT may be unnecessary in patients achieving a metabolic complete remission. The primary-endpoint analysis per arm will be reported when >80% will have a minimum post-treatment follow-up of 30 months. Herein we present a preliminary analysis of the outcomes after different induction regimens in the whole study population. Methods: Patients with newly diagnosed PMBCL were eligible. Initial therapy was to be based on a combination containing rituximab and anthracyclines. The regimen was chosen according to local practice. Upon central review of post-induction PET scans, responding patients were randomized to observation versus consolidative RT. Responses were defined according to the Lugano classification using the Deauville 5-point scale (DS). Patients progressing during induction did not have central PET review and in the present analysis were assigned DS score 5. Results: 545 patients (209 men, 336 women) were enrolled and treated with R-V/MACOP-B (n = 168, 31%), R-CHOP14 (n = 146, 27%), R-CHOP21 (n = 98, 18%), DA-EPOCH-R (n = 88, 16%), R-megaCHOP (n = 19, 3%), other dose-intensive regimen (n = 26, 5%). At a median follow up of 3 years, approx. 95% of patients are alive. The rate of complete metabolic responses (CR, defined by DS 1-3) did not differ significantly across regimens, however an unbalanced distribution of DS score was evident, apparently due to the rate of patients with a probable induction failure (DS5) more than 2 times higher for CHOP21 in comparison to the other regimens. At preliminary univariate analysis there was no significant association of advanced stage, older age, extranodal infiltration, poor performance status, bulky disease, unfavorable international prognostic index (IPI) and larger metabolic tumor volume (MTV) with the use of CHOP21. Patients receiving DA-EPOCH-R were somehow younger than the rest. The research was funded by: IELSG37 was supported in part by grants from Swiss National Science Foundation (SNSF) – Project 32003B_146931,Krebsforschung Schweiz – Projec KFS-2852-08-2011 and Cancer Research UK (C30423/A16247)The enrolment of Swiss patients was supported by the Swiss Group for Clinical Cancer Research (SAKK) Keywords: Chemotherapy Combination, Therapies Immunotherapy No conflicts of interests pertinent to the abstract.
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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 | 0.001 |
| 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".