The impact of graft-versus-host disease on the relapse rate in patients with lymphoma depends on the histological subtype and the intensity of the conditioning regimen Journal Article
| Authors: | Urbano-Ispizua, A.; Pavletic, S. Z.; Flowers, M. E.; Klein, J. P.; Zhang, M. J.; Carreras, J.; Montoto, S.; Perales, M. A.; Aljurf, M. D.; Akpek, G.; Bredeson, C. N.; Costa, L. J.; Dandoy, C.; Freytes, C. O.; Fung, H. C.; Gale, R. P.; Gibson, J.; Hamadani, M.; Hayashi, R. J.; Inamoto, Y.; Inwards, D. J.; Lazarus, H. M.; Maloney, D. G.; Martino, R.; Munker, R.; Nishihori, T.; Olsson, R. F.; Rizzieri, D. A.; Reshef, R.; Saad, A.; Savani, B. N.; Schouten, H. C.; Smith, S. M.; Socié, G.; Wirk, B.; Yu, L. C.; Saber, W. |
| Article Title: | The impact of graft-versus-host disease on the relapse rate in patients with lymphoma depends on the histological subtype and the intensity of the conditioning regimen |
| Abstract: | The purpose of this study was to analyze the impact of graft-versus-host disease (GVHD) on the relapse rate of different lymphoma subtypes after allogeneic hematopoietic cell transplantation (allo-HCT). Adult patients with a diagnosis of Hodgkin lymphoma, diffuse large B cell lymphoma, follicular lymphoma (FL), peripheral T cell lymphoma, or mantle cell lymphoma (MCL) undergoing HLA-identical sibling or unrelated donor hematopoietic cell transplantation between 1997 and 2009 were included. Two thousand six hundred eleven cases were included. A reduced-intensity conditioning (RIC) regimen was used in 62.8% of the transplantations. In a multivariate analysis of myeloablative cases (n = 970), neither acute (aGVHD) nor chronic GVHD (cGVHD) were significantly associated with a lower incidence of relapse/progression in any lymphoma subtype. In contrast, the analysis of RIC cases (n = 1641) showed that cGVHD was associated with a lower incidence of relapse/progression in FL (risk ratio [RR], .51; P = .049) and in MCL (RR, .41; P = .019). Patients with FL or MCL developing both aGVHD and cGVHD had the lowest risk of relapse (RR, .14; P = .007; and RR, .15; P = .0019, respectively). Of interest, the effect of GVHD on decreasing relapse was similar in patients with sensitive disease and chemoresistant disease. Unfortunately, both aGVHD and cGVHD had a deleterious effect on treatment-related mortality and overall survival (OS) in FL cases but did not affect treatment-related mortality, OS or PFS in MCL. This study reinforces the use of RIC allo-HCT as a platform for immunotherapy in FL and MCL patients. © 2015 American Society for Blood and Marrow Transplantation. |
| Keywords: | adult; aged; major clinical study; overall survival; recurrence risk; cancer immunotherapy; progression free survival; mantle cell lymphoma; cancer mortality; hodgkin disease; peripheral t cell lymphoma; acute graft versus host disease; chronic graft versus host disease; lymphoma; graft versus host reaction; reduced intensity conditioning; donor lymphocyte infusion; allogeneic hematopoietic stem cell transplantation; large cell lymphoma; sibling; tacrolimus; follicular lymphoma; cyclosporin; autologous hematopoietic stem cell transplantation; graft-versus-host disease; human; male; female; article |
| Journal Title: | Biology of Blood and Marrow Transplantation |
| Volume: | 21 |
| Issue: | 10 |
| ISSN: | 1083-8791 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2015-10-01 |
| Start Page: | 1746 |
| End Page: | 1753 |
| Language: | English |
| DOI: | 10.1016/j.bbmt.2015.05.010 |
| PROVIDER: | scopus |
| PMCID: | PMC4568162 |
| PUBMED: | 25981509 |
| DOI/URL: | |
| Notes: | Export Date: 2 October 2015 -- Source: Scopus |
