医学
队列
耐火材料(行星科学)
内科学
单中心
队列研究
肿瘤科
天体生物学
物理
作者
Allison M. Bock,Raphael Mwangi,Yucai Wang,Arushi Khurana,Mathew S. Maurer,Amy Ayers,Brad S. Kahl,Peter Martin,Jonathon B. Cohen,Carla Casulo,Izidore S. Lossos,Umar Farooq,Sabarish Ayyappan,Tanner Wayne Reicks,Thomas M. Habermann,Thomas E. Witzig,Christopher R. Flowers,James R. Cerhan,Loretta J. Nastoupil,Grzegorz S. Nowakowski
出处
期刊:Blood Advances
[American Society of Hematology]
日期:2024-04-26
标识
DOI:10.1182/bloodadvances.2024012760
摘要
Patients with large B-cell lymphoma (LBCL) that fail to achieve a complete response (CR) or relapse early after anthracycline-containing immunochemotherapy (IC) have a poor prognosis and are commonly considered "primary refractory disease". However, different definitions of primary refractory disease are used in the literature and clinical practice. In this study, we ex-amined variation in the time to relapse used to define refractory status and association with sur-vival outcomes in patients with primary refractory LBCL in a single-center prospective cohort with a validation in an independent multi-center cohort. Newly diagnosed LBCL patients were enrolled in the Molecular Epidemiological Resource cohort (MER; N=949) or the Lymphoma Epidemiology of Outcomes cohort (LEO; N=2,755) from 9/2002 to 5/2021. Primary refractory LBCL was defined as no response (SD) or progressive disease (PD) during or by the end of frontline (1L) IC (primary PD; PPD), partial response at end of treatment (EOT PR), or relapse within 3-12 months after achieving CR at EOT to 1L IC (early relapse). In the MER cohort, pa-tients with PPD had inferior OS (2-year OS rate 15% MER, 31% LEO) when compared to other subgroups considered in defining primary refractory disease, EOT PR (2-year OS rate 38% MER, 50% LEO) and early relapse (2-year OS rate 44% MER, 58% LEO). Among patients re-ceiving frontline IC with curative intent, we identified that patients with PPD are the key sub-group with poor outcomes. We propose a definition of primary refractory LBCL as SD or PD during or by the end of 1L treatment.
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