在接受HLA-单倍体相合异基因造血干细胞移植（Haplo-HCT）和移植后环磷酰胺（PTCy）治疗的患者中，移植物抗宿主病（GVHD）的发生与急性髓细胞性白血病（AML）复发之间的关系仍然存在争议。这里,我们解决了移植时活动性AML患者的这一问题.2年累积复发率和无白血病生存率（LFS）分别为49%和32.3%，分别。任何级别的急性或慢性GVHD与较低的复发率之间没有关联。然而,I级急性GVHD与较好的LFS相关(HR=0.71,95%CI0.51-0.99,P=0.04).相比之下,III-IV级急性（HR=3.09，95％CI1.87-5.12，P<0.0001）和广泛慢性（HR=3.3，95％CI1.81-6.04，P=0.0001）GVHD与较高的非复发死亡率相关，导致较低的LFS（HR=1.36，95％CI0.99-1.86，P=0.056和HR=1.97，95％CI1.35-2.89，P总之,这些数据提示,在使用基于PTCy的Haplo-HCT治疗的活动性AML患者中,移植物抗白血病效应与GVHD分离.
The association between graft-versus-host disease (GVHD) occurrence and acute myeloid leukemia (AML) relapse in patients treated with HLA-haploidentical allogeneic hematopoietic stem cell transplantation (Haplo-HCT) with post-transplant cyclophosphamide (
PTCy)-based GVHD prophylaxis has remained debated. Here, we addressed this issue in patients with active AML at transplantation. 2-year cumulative incidences of relapse and leukemia-free survival (LFS) were 49% and 32.3%, respectively. There were no associations between acute nor chronic GVHD of any grade and lower relapse incidence. However, grade I acute GVHD was associated with better LFS (HR = 0.71, 95% CI 0.51-0.99, P = 0.04). In contrast, grade III-IV acute (HR = 3.09, 95% CI 1.87-5.12, P < 0.0001) as well as extensive chronic (HR = 3.3, 95% CI 1.81-6.04, P = 0.0001) GVHD correlated with higher nonrelapse mortality leading to lower LFS (HR = 1.36, 95% CI 0.99-1.86, P = 0.056 and HR = 1.97, 95% CI 1.35-2.89, P = 0.0004, respectively). In conclusion, these data suggest a dissociation of graft-versus-leukemia effects from GVHD in patients with active AML treated with
PTCy-based Haplo-HCT.
