Outcomes of transplant-eligible and transplant-ineligible patients with mantle cell lymphoma in Ontario
Bibliographic record
Abstract
The frontline treatment of patients with mantle cell lymphoma (MCL) varies in practice. We conducted a retrospective, population-based study of patients with MCL from 2005 to 2020. We defined transplant-eligible (TE) patients as those aged <70 years who received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) or R-CHOP/R-DHAP (rituximab, dexamethasone, high-dose cytarabine and dexamethasone) and transplant-ineligible (TI) patients as those aged ≥70 years and treated with bendamustine-rituximab (BR) or other chemoimmunotherapy regimens. The primary outcome was 5-year overall survival (OS), and secondary outcomes included toxicities and health care use. We identified 426 TE patients, of whom 254 received R-CHOP and 172 received R-CHOP/R-DHAP. More patients who received R-CHOP/R-DHAP also received an autologous stem cell transplant (ASCT). The 5-year OS for patients treated with R-CHOP/R-DHAP was 70.5% compared with 62.0% for patients treated with R-CHOP, regardless of transplant status. R-CHOP/R-DHAP had more hospital admissions for fever, infection, neutropenia, and renal toxicity. TI patients received BR (n = 303) or historical regimens (n = 189). BR was associated with lower mortality. After adjustment, maintenance rituximab was associated with significantly lower mortality (hazard ratio, 0.33; 95% confidence interval, 0.24-0.44). More patients treated with BR had hospital admissions for febrile neutropenia. In this large population-based study, R-CHOP/R-DHAP before ASCT showed a trend toward improved 5-year OS. BR did not result in superior OS after adjustment, suggesting other regimens followed by rituximab maintenance may be reasonable.
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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".