GVHD对淋巴瘤进展的影响：来自日本移植与细胞疗法学会的全国性研究。
Impact of GVHD on lymphoma progression: Nationwide study from Japanese Society for Transplantation and Cellular Therapy.
发表日期：2023 Aug 23
作者：
Mizuki Watanabe, Junya Kanda, Takahiro Fukuda, Naoyuki Uchida, Kazuhiro Ikegame, Keisuke Kataoka, Hikaru Kobayashi, Takahide Ara, Jun Ishikawa, Ken-Ichi Matsuoka, Yasuhiro Sugio, Hideyuki Nakazawa, Takashi Ikeda, Yoshiko Atsuta, Eisei Kondo, Ritsuro Suzuki,
来源：
BRITISH JOURNAL OF HAEMATOLOGY
摘要：
淋巴瘤葛兰素反应（GVL）效应及其与急性和慢性移植物抗宿主病（aGVHD、cGVHD）的关联尚未全面阐明。我们对2204名日本非霍奇金淋巴瘤患者（病症缓慢型B-非霍奇金淋巴瘤，n = 689；侵袭性B-非霍奇金淋巴瘤，n = 720；成熟型T/NK-非霍奇金淋巴瘤，n = 795）在2003年至2017年接受第一次异基因造血干细胞移植的回顾性分析。移植前淋巴瘤控制发现完全缓解（CR）患者759例，非CR患者1445例。我们评估了aGVHD/cGVHD对淋巴瘤进展和其他结果的影响。尽管总体队列中aGVHD/cGVHD对淋巴瘤进展没有统计学影响，但它们在某些群体中的影响是明确的：CR患者中的I-II级aGVHD（HR，0.63；95％CI，0.43-0.91）尤其是在成熟型T/NK-非霍奇金淋巴瘤中（HR，0.46；95％CI，0.26-0.83），以及成熟型侵袭性B-非霍奇金淋巴瘤患者中的广泛cGVHD（HR，0.55；95% CI，0.31-0.97）。总体而言，有限的cGVHD与较好的生存率相关（无进展存活率：HR，0.71；95% CI，0.56-0.90），而严重的GVHD对其产生负面影响。我们的研究结果支持了GVL效应与不同淋巴瘤亚型/控制中GVHD的差异关联的存在。与此同时，也提出了我们应该在有限的活性范围内管理GVHD，考虑到严重GVHD的负面影响。由于移植前淋巴瘤控制仍然是影响移植结果的重要因素，改善其管理是一个重要问题需要解决。© 2023 British Society for Haematology and John Wiley & Sons Ltd.
The 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.© 2023 British Society for Haematology and John Wiley & Sons Ltd.