The effect of graft‐versus‐host disease on outcomes after allogeneic stem cell transplantation for refractory lymphoblastic lymphoma in children and young adults

Abstract

Background Patients with relapsed or refractory lymphoblastic lymphoma (LBL) have a poor prognosis. The efficacy of allogeneic blood stem cell transplantation for treatment of this disease remains unclear in terms of transplantation‐related toxicity. Acute and chronic graft‐versus‐host diseases (GVHD) are both harmful to patients after allogeneic transplantation, but may have some positive effects through a substitute graft‐versus‐lymphoma effect. Methods To investigate the effect of GVHD on the survival of patients with refractory LBL, we retrospectively studied the outcomes of 213 patients with LBL who underwent first allogeneic stem cell transplantation before the age of 18 years, between 1990 and 2015 in Japan. Results The five‐year overall survival (OS) and event‐free survival rates after stem cell transplantation were 50.3% (95% confidence interval [CI], 43.2‐56.9) and 47.8% (95% CI, 40.8‐54.4), respectively. In univariate landmark analyses, the probability of OS was significantly better in patients with aGVHD than in those without (P = 0.002, five‐year OS 58.1% vs 39.0%). The probability of OS was also better in patients with cGVHD than in those without (P = 0.036, five‐year OS 72.2% vs 54.7%). Multivariate analysis demonstrated that only aGVHD was associated with better OS (hazard ratio, 0.63; 95% CI, 0.42‐0.94, P = 0.024). Progression and recurrence statuses at SCT were associated with poor prognosis. The patients with grade II aGVHD showed the best prognosis (five‐year OS: 65.6%). Conclusion Our results suggest that the occurrence of aGVHD may be associated with better outcomes in patients with relapsed/refractory LBL who undergo allogeneic transplantation.

Comparison of Allogeneic Stem Cell Transplant and Autologous Stem Cell Transplant in Refractory or Relapsed Peripheral T-Cell Lymphoma

“…However, the roles of autologous HSCT and allogeneic HSCT in R/R-PTCL remain far more controversial. Although HSCT has certain beneficial effects, adverse events (AEs) will negatively influence survival as well . Therefore, this meta-analysis was performed to compare the efficacy and safety of autologous HSCT vs allogeneic HSCT in R/R-PTCL.…”

Allogeneic haematopoietic stem cell transplantation for adult T‐lymphoblastic lymphoma: A real‐world multicentre analysis in China

“…This suggested that graft‐versus‐lymphoma effect may partially overcome the poor prognostic significance of high‐risk features before HSCT. Similarly, several studies also reported that LBL/ALL patients, particularly those with relapsed/refractory disease, could benefit from graft‐versus‐lymphoma effect 56,57 …”

“…Similarly, several studies also reported that LBL/ALL patients, particularly those with relapsed/refractory disease, could benefit from graft-versus-lymphoma effect. 56,57 In the study of Levine et al 11 the 1-year and 2-year cumulative incidence of relapse was 32% and 34%, respectively, in LBL patients receiving matched sibling donor (MSD) allo-HSCT. In the present study, the 2-year cumulative incidence of disease progression was only 21%.…”

Selection of hematopoietic stem cell transplantation for T-cell lymphoblastic lymphoma

“…The NHL-BFM Study Group also reported that allo-HSCT is the only good prognostic factor for patients with relapsed LBL ( 26 ). The occurrence of aGVHD may be associated with better outcomes in patients with relapsed/refractory LBL who undergo allogeneic transplantation ( 27 ). Moreover, achieving CR1 before allo-HSCT is associated with a favorable OS, regardless of the disease subtype ( 28 ).…”