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
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MSK Authors
  1. Miguel-Angel Perales
    398 Perales