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

Alvaro Urbano-Ispizua*, Steven Z. Pavletic, Mary E. Flowers, John P. Klein, Mei-Jie Zhang, Jeanette Carreras, Silvia Montoto, Miguel-Angel Perales, Mahmoud D. Aljurf, Goerguen Akpek, Christopher N. Bredeson, Luciano J. Costa, Christopher Dandoy, Cesar O. Freytes, Henry C. Fung, Robert Peter Gale, John Gibson, Mehdi Hamadani, Robert J. Hayashi, Yoshihiro InamotoDavid J. Inwards, Hillard M. Lazarus, David G. Maloney, Rodrigo Martino, Reinhold Munker, Taiga Nishihori, Richard F. Olsson, David A. Rizzieri, Ran Reshef, Ayman Saad, Bipin N. Savani, Harry C. Schouten, Sonali M. Smith, Gerard Socie, Baldeep Wirk, Lolie C. Yu, Wael Saber

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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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. American Society for Blood and Marrow Transplantation.
Original languageEnglish
Pages (from-to)1746-1753
JournalBiology of Blood and Marrow Transplantation
Volume21
Issue number10
DOIs
Publication statusPublished - Oct 2015

Keywords

  • Graft-versus-host disease
  • Lymphoma

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