The Challenges of GVHD in Patients with Lymphoma

Daniel H. Fowler, MD, senior investigator, Center for Cancer Research, National Cancer Institute, discusses the challenges of graph-versus-host-disease (GVHD) in patients with high-risk lymphoma.

The most common problem when trying to cure lymphoma with a transplant is the lack of ability to control the disease, Fowler says. High-risk lymphoma types, such as diffuse large-cell lymphoma, transformed lymphoma, T cell lymphoma, and Hodgkin’s lymphoma, are more difficult to cure with a transplant when compared to other lymphoma types.

Fowler says another problem is that older patients do not handle the transplant well. Unfortunately, the median age of transplant patients with lymphoma is over 50 years old. Fowler says doctors have responded to this issue by reducing the amount of chemotherapy and radiation prior to the transplant, in order to get better results.

Another important aspect in the lymphoma transplant field is the patient’s disease state, Fowler says. Patients in complete remission or partial remission respond better than patients whose lymphoma is not responding to chemotherapy.

Fowler says half of his lymphoma patients are in the category of not responding to chemotherapy, but in clinical trials, these patients are seeing some favorable results.

Clinical Pearls

• Patients with high-risk lymphoma subtypes do not respond as well to transplants
• Older patients with lymphoma do not respond well to transplants but changes to chemotherapy and radiation therapy before the transplant yield better results
• The state of the patient’s disease also plays a role in treating lymphoma by using transplants