Impact of GVHD on lymphoma progression: Nationwide study from Japanese Society for Transplantation and Cellular Therapy

Abstract

SummaryThe graft‐versus‐lymphoma (GVL) effect and its association with acute and chronic GVHD (aGVHD, cGVHD) has not been comprehensively elucidated. We retrospectively analysed 2204 Japanese patients with non‐Hodgkin lymphomas (NHLs; indolent B‐NHLs, n = 689; aggressive B‐NHLs, n = 720; mature T/NK‐NHLs, n = 795) receiving a first allo‐HSCT in 2003–2017. Pre‐transplant lymphoma control showed complete response (CR) in 759 and non‐CR in 1445. We assessed the impact of aGVHD/cGVHD on lymphoma progression and other outcomes. Although aGVHD/cGVHD showed no statistical impact on lymphoma progression in the overall cohort, their impact was clear in certain groups: Grade I‐II aGVHD in CR patients (HR, 0.63; 95% CI, 0.43–0.91), especially in mature T/NK‐NHL (HR, 0.46; 95% CI, 0.26–0.83) and extensive cGVHD in patients with mature aggressive B‐NHLs (HR, 0.55; 95% CI, 0.31–0.97). In total, limited cGVHD was associated with superior survivals (progression‐free survival: HR, 0.71; 95% CI, 0.56–0.90), whereas severe GVHDs showed negative impacts on them. Our results support the presence of GVL effects differentially associated with GVHD in different lymphoma subtypes/controls. Meanwhile, it was also suggested that we should manage GVHDs within a limited activity, considering the negative impact of severe GVHDs. As pre‐transplant lymphoma control remains a strong factor influencing transplant outcomes, improving its management is an important issue to be addressed.