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
Por:
Urbano-Ispizua, A, Pavletic, SZ, Flowers, ME, Klein, JP, Zhang, MJ, Carreras, J, Montoto, S, Perales, MA, Aljurf, MD, Akpek, G, Bredeson, CN, Costa, LJ, Dandoy, C, Freytes, CO, Fung, HC, Gale, RP, Gibson, J, Hamadani, M, Hayashi, RJ, Inamoto, Y, Inwards, DJ, Lazarus, HM, Maloney, DG, Martino, R, Munker, R, Nishihori, T, Olsson, RF, Rizzieri, DA, Reshef, R, Saad, A, Savani, BN, Schouten, HC, Smith, SM, Socie, G, Wirk, B, Yu, LC, Saber, W
Publicada:
1 oct 2015
Resumen:
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 = 3.049) 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. (C) 2015 American Society for Blood and Marrow Transplantation.
Filiaciones:
Urbano-Ispizua, A:
Univ Barcelona, Hosp Clin, IDIBAPS, Dept Hematol, Barcelona, Spain
Inst Res Josep Carreras, Barcelona, Spain
Pavletic, SZ:
NCI, Expt Transplantat & Immunol Branch, Ctr Canc Res, Bethesda, MD 20892 USA
Flowers, ME:
Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98104 USA
Klein, JP:
Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA
Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA
Zhang, MJ:
Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA
Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA
Carreras, J:
Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA
Montoto, S:
Barts Hlth NHS Trust, St Bartholomews Hosp, Dept Haematooncol, London, England
Perales, MA:
Mem Sloan Kettering Canc Ctr, Dept Med, Bone Marrow Transplant Serv, New York, NY 10021 USA
Aljurf, MD:
King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia
Akpek, G:
Banner MD Anderson Canc Ctr, Hematol Oncol Sect, Gilbert, AZ USA
Bredeson, CN:
Ottawa Hosp, Blood & Marrow Transplant Program, Ottawa, ON, Canada
Ottawa Hosp, Res Inst, Ottawa, ON, Canada
Costa, LJ:
Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA
Dandoy, C:
Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA
Freytes, CO:
South Texas Vet Hlth Care Syst, San Antonio, TX USA
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
Fung, HC:
Temple Hlth, Fox Chase Canc Ctr, Dept Med Oncol, Philadelphia, PA USA
Gale, RP:
Univ London Imperial Coll Sci Technol & Med, Dept Med, Div Expt Med, Hematol Res Ctr, London, England
Gibson, J:
Royal Prince Alfred Hosp, Inst Haematol, Camperdown, NSW 2050, Australia
Hamadani, M:
Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA
Hayashi, RJ:
Washington Univ, Sch Med, Dept Pediat, Div Pediat Hematol Oncol, St Louis, MO 63110 USA
Inamoto, Y:
Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98104 USA
Inwards, DJ:
Mayo Clin, Div Hematol, Rochester, MN USA
Lazarus, HM:
Univ Hosp Case Med Ctr, Seidman Canc Ctr, Cleveland, OH USA
Maloney, DG:
Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98104 USA
Martino, R:
Hosp Santa Creu & Sant Pau, Div Hematol, Barcelona, Spain
Munker, R:
Louisiana State Univ Hlth, Dept Internal Med, Div Hematol Oncol, Shreveport, LA USA
Nishihori, T:
Univ S Florida, Coll Med, H Lee Moffitt Canc Ctr & Res Inst, Dept Med Oncol, Tampa, FL 33612 USA
Olsson, RF:
Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden
Uppsala Univ, Ctr Clin Res Sormland, Uppsala, Sweden
Rizzieri, DA:
Duke Univ, Div Hematol Malignancies & Cellular Therapy, Durham, NC USA
Reshef, R:
Univ Penn, Dept Med, Abramson Canc Ctr, Med Ctr, Philadelphia, PA 19104 USA
Saad, A:
Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA
Savani, BN:
Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA
Schouten, HC:
Acad Ziekenhuis, Dept Hematol, Maastricht, Netherlands
Smith, SM:
Univ Chicago, Hematol Oncol Sect, Chicago, IL 60637 USA
Socie, G:
Hop St Louis, Dept Hematol, Paris, France
Wirk, B:
SUNY Stony Brook, Med Ctr, Dept Internal Med, Stony Brook, NY 11794 USA
Yu, LC:
Louisiana State Univ, Med Ctr, Childrens Hosp, Div Hematol Oncol,Ctr Canc & Blood Disorders, New Orleans, LA USA
Saber, W:
Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA
Hybrid Gold, Green Accepted
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