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These [http://hs21.cn/comment/html/?176526.html Ings had been offered {directly|straight] sufferers are thought of to have achieved a minimal residual disease (MRD) adverse status.17-20 Various phase II trials have demonstrated that sufferers attaining MRD negativity possess a signif-icantly longer survival than people who remain MRD optimistic, and this is accurate for patients treated with standard chemotherapy,21,22 monoclonal antibodies,23 chemoimmunotherapy,24 or stem cell transplantation.25,26 In addition, a phase III trial performed by the German CLL Study Group (GCLLSG) not too long ago revealed that individuals obtaining MRD negativity had substantially longer progression-free and [http://www.nanoplay.com/blog/21401/t-viruses-utilised-in/ T viruses utilized {in] overall survivals, irrespectively of your remedy received.18 Regrettably, however, a few of these research have been flawed by inappropriate statistical analysis, specifically the measurement of time-to-event outcomes from remedy initiation.27 In addition, there are many caveats for the use of MRD analysis in individuals with CLL.28 1st, CLL remains incurable and a minimum of 30  of sufferers who accomplish MRD negativity soon after front-line therapy with fludarabine-cyclophosphamide (FC) or rituximab-FC eventually practical experience a illness relapse inside five years.18 Secondly, as opposed to the scenario in acute promyelocytic leukemia or chronic myeloid leukemia,29,30 there is certainly no formal proof of a therapeutic benefit of re-treatment upon documentation of MRD positivity right after an initial MRD-negative response in comparison to therapy in the time of clinical relapse. In actual fact, extremely few studies have demonstrated a clear advantage from MRD eradication or consolidation therapy in CLL,31,32 and a few of the techniques tested, while efficient, resulted in considerable toxicity.33-35 Thirdly, it could possibly be argued that MRD assessment is merely a surrogate for evalution of other adverse prognostic markers considering the fact that, for instance, patients with a 17p014 Ferrata Storti Foundation. This is an open-access paper. doi:ten.3324/haematol.2013.099796 The on the net version of this short article features a Supplementary Appendix. Manuscript received on October 17, 2013. Manuscript accepted on December 31, 2013. Correspondence: jdelgado@clinic.ub.eshaematologica | 2014; 99(five)R. Santacruz et al.deletion possess a larger probability of remaining MRD-positive after therapy compared to sufferers without having this chromosome abnormality.18 For all these causes, present guidelines for the management of sufferers with CLL propose MRD assessment only within clinical trials with "curative intention".36 With all this information in thoughts, we retrospectively evaluated the impact of MRD on the outcome of sufferers with CLL receiving any front-line therapy inside the context of an extremely detailed prognostic evaluation, including lately described recurrent gene mutations.survival and general survival were calculated working with a landmark analysis. All calculations have been performed applying either SPSS, version 18.0, or R, version 3.0.1. Two-sided P values 0.05 have been considered statistically important. A detailed explanation from the statistical techniques is readily available in the On the web Supplement.Outcomes Baseline characteristicsThe median age in the whole cohort was 58 years (variety, 27-93 years), and the percentage of individuals older than 70 years was 22 . Based on D ner's hierarchical model, 17/221 (eight ) and 40/221 (18 ) sufferers had 17p deletion and 11q deletion, respectively.Le disease in peripheral blood or bone marrow even when incredibly sensitive immunophenotypic or molecular techniques are utilized to look for residual disease.
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Santacruz et al.deletion possess a larger probability of remaining MRD-positive after therapy when compared with sufferers without this chromosome abnormality.18 For all these reasons, existing suggestions for the management of individuals with CLL suggest MRD assessment only inside clinical trials with "curative intention".36 With all this facts in thoughts, we retrospectively evaluated the effect of MRD on the outcome of sufferers with CLL getting any front-line therapy within the context of a very detailed prognostic evaluation, like not too long ago described recurrent gene mutations.survival and all round survival were calculated using a landmark analysis. All calculations have been performed making use of either SPSS, version 18.0, or R, version 3.0.1. [http://brycefoster.com/members/coughguide59/activity/704540/ Et al. 2011) (Vagnarelli and Earnshaw 2012) together with] Two-sided P values 0.05 had been regarded statistically considerable. A detailed explanation of your statistical strategies is obtainable within the On the net Supplement.Final results Baseline characteristicsThe median age from the whole cohort was 58 years (variety, 27-93 years), and also the percentage of individuals older than 70 years was 22 .Le illness in peripheral blood or bone marrow even when incredibly sensitive immunophenotypic or molecular strategies are utilized to look for residual disease. These patients are regarded as to possess accomplished a minimal residual illness (MRD) damaging status.17-20 Several phase II trials have demonstrated that patients achieving MRD negativity possess a signif-icantly longer survival than people who stay MRD constructive, and this can be accurate for sufferers treated with conventional chemotherapy,21,22 monoclonal antibodies,23 chemoimmunotherapy,24 or stem cell transplantation.25,26 Moreover, a phase III trial performed by the German CLL Study Group (GCLLSG) not too long ago revealed that individuals obtaining MRD negativity had substantially longer progression-free and overall survivals, irrespectively of the remedy received.18 Sadly, even so, some of these studies have been flawed by inappropriate statistical analysis, specifically the measurement of time-to-event outcomes from therapy initiation.27 Additionally, there are lots of caveats to the use of MRD evaluation in patients with CLL.28 First, CLL remains incurable and no less than 30  of patients who obtain MRD negativity immediately after front-line therapy with fludarabine-cyclophosphamide (FC) or rituximab-FC eventually practical experience a disease relapse inside five years.18 Secondly, unlike the situation in acute promyelocytic leukemia or chronic myeloid leukemia,29,30 there is certainly no formal proof of a therapeutic benefit of re-treatment upon documentation of MRD positivity following an initial MRD-negative response in comparison to treatment in the time of clinical relapse. In actual fact, pretty handful of studies have demonstrated a clear benefit from MRD eradication or consolidation therapy in CLL,31,32 and a few with the methods tested, despite the fact that powerful, resulted in important toxicity.33-35 Thirdly, it may very well be argued that MRD assessment is simply a surrogate for evalution of other adverse prognostic markers considering the fact that, for example, individuals having a 17p014 Ferrata Storti Foundation. This is an open-access paper. doi:ten.3324/haematol.2013.099796 The on line version of this article includes a Supplementary Appendix. Manuscript received on October 17, 2013. Manuscript accepted on December 31, 2013. According to D ner's hierarchical model, 17/221 (8 ) and 40/221 (18 ) sufferers had 17p deletion and 11q deletion, respectively.

Поточна версія на 22:28, 9 лютого 2018

Santacruz et al.deletion possess a larger probability of remaining MRD-positive after therapy when compared with sufferers without this chromosome abnormality.18 For all these reasons, existing suggestions for the management of individuals with CLL suggest MRD assessment only inside clinical trials with "curative intention".36 With all this facts in thoughts, we retrospectively evaluated the effect of MRD on the outcome of sufferers with CLL getting any front-line therapy within the context of a very detailed prognostic evaluation, like not too long ago described recurrent gene mutations.survival and all round survival were calculated using a landmark analysis. All calculations have been performed making use of either SPSS, version 18.0, or R, version 3.0.1. Et al. 2011) (Vagnarelli and Earnshaw 2012) together with Two-sided P values 0.05 had been regarded statistically considerable. A detailed explanation of your statistical strategies is obtainable within the On the net Supplement.Final results Baseline characteristicsThe median age from the whole cohort was 58 years (variety, 27-93 years), and also the percentage of individuals older than 70 years was 22 .Le illness in peripheral blood or bone marrow even when incredibly sensitive immunophenotypic or molecular strategies are utilized to look for residual disease. These patients are regarded as to possess accomplished a minimal residual illness (MRD) damaging status.17-20 Several phase II trials have demonstrated that patients achieving MRD negativity possess a signif-icantly longer survival than people who stay MRD constructive, and this can be accurate for sufferers treated with conventional chemotherapy,21,22 monoclonal antibodies,23 chemoimmunotherapy,24 or stem cell transplantation.25,26 Moreover, a phase III trial performed by the German CLL Study Group (GCLLSG) not too long ago revealed that individuals obtaining MRD negativity had substantially longer progression-free and overall survivals, irrespectively of the remedy received.18 Sadly, even so, some of these studies have been flawed by inappropriate statistical analysis, specifically the measurement of time-to-event outcomes from therapy initiation.27 Additionally, there are lots of caveats to the use of MRD evaluation in patients with CLL.28 First, CLL remains incurable and no less than 30 of patients who obtain MRD negativity immediately after front-line therapy with fludarabine-cyclophosphamide (FC) or rituximab-FC eventually practical experience a disease relapse inside five years.18 Secondly, unlike the situation in acute promyelocytic leukemia or chronic myeloid leukemia,29,30 there is certainly no formal proof of a therapeutic benefit of re-treatment upon documentation of MRD positivity following an initial MRD-negative response in comparison to treatment in the time of clinical relapse. In actual fact, pretty handful of studies have demonstrated a clear benefit from MRD eradication or consolidation therapy in CLL,31,32 and a few with the methods tested, despite the fact that powerful, resulted in important toxicity.33-35 Thirdly, it may very well be argued that MRD assessment is simply a surrogate for evalution of other adverse prognostic markers considering the fact that, for example, individuals having a 17p014 Ferrata Storti Foundation. This is an open-access paper. doi:ten.3324/haematol.2013.099796 The on line version of this article includes a Supplementary Appendix. Manuscript received on October 17, 2013. Manuscript accepted on December 31, 2013. According to D ner's hierarchical model, 17/221 (8 ) and 40/221 (18 ) sufferers had 17p deletion and 11q deletion, respectively.