The association of graft-versus-host disease (GVHD) and graft-versus-leukemia (GVL) effects after allogeneic stem-cell transplantation (SCT) is well-established but was not confirmed in the modern era and following post-transplant cyclophosphamide (PTCy). We assessed GVHD/ GVL association in AML patients following HLA-matched SCT with standard calcineurin-based (n = 12,653, 57% with additional in-vivo T-cell depletion) or PTCy-based (n = 508) GVHD prophylaxis. Following standard prophylaxis, acute GVHD grade II-IV and III-IV, chronic GVHD, and extensive chronic GVHD rates were 23.8%, 7.5%, 37.0%, and 16.3%, respectively. Acute GVHD grade II and III-IV were associated with lower relapse [hazard-ratio (HR) 0.85, P = 0.002; HR 0.76, P = 0.003, respectively)], higher non-relapse mortality (NRM) (HR 1.5, P < 0.001; HR 6.21, P < 0.001) and lower overall survival (OS) (HR 1.49, P < 0.001; HR 6.1, P < 0.001). Extensive chronic GVHD predicted lower relapse (HR 0.69, P < 0.001), higher NRM (HR 2.83, P < 0.001), and lower OS (HR 2.74, P < 0.001). Following PTCy, GVHD rates were 22.8%, 6.2%, 35.5%, and 17.7%, respectively. Acute GVHD was not associated with relapse (HR 1.37, P = 0.15) but predicted higher NRM (HR 3.34, P < 0.001) and lower OS (HR 1.92, P = 0.001). Chronic GVHD was not prognostic for these outcomes. In conclusion, GVHD and GVL are strongly associated with contemporary SCT. However, following PTCy, GVHD is not associated with reduced relapse.

同种异体干细胞移植 （SCT） 后移植物抗宿主病 （GVHD） 和移植物抗白血病 （GVL） 效应的关联已得到明确，但在现代和移植后环磷酰胺 （PTCy） 之后尚未得到证实。我们评估了 HLA 匹配 SCT 与基于标准钙调神经磷酸酶 （n = 12,653， 57% 有额外的体内 T 细胞耗竭） 或基于 PTCy （n = 508） GVHD 预防后 AML 患者的 GVHD/GVL 关联。标准预防后，急性 GVHD II-IV 级和 III-IV 级、慢性 GVHD 和广泛慢性 GVHD 的发生率分别为 23.8% 、 7.5% 、 37.0% 和 16.3%。急性 GVHD II 级和 III-IV 级与较低的复发率相关 [风险比 （HR） 0.85，P = 0.002; HR 0.76，分别为 P = 0.003）]，较高的非复发死亡率 （NRM） （HR 1.5，P < 0.001;HR 6.21，P < 0.001）和较低的总生存期 （OS） （HR 1.49，P < 0.001; HR 6.1，P < 0.001）。 广泛性慢性 GVHD 预测复发率较低 （HR 0.69，P < 0.001），NRM 较高 （HR 2.83，P < 0.001） 和较低 OS （HR 2.74，P < 0.001）。PTCy 后，GVHD 发生率分别为 22.8% 、 6.2% 、 35.5% 和 17.7%。急性 GVHD 与复发无关 （HR 1.37，P = 0.15），但预测 NRM 较高 （HR 3.34，P < 0.001） 和较低 OS （HR 1.92，P = 0.001）。 慢性 GVHD 对这些结局没有预后影响。总之，GVHD 和 GVL 与当代 SCT 密切相关。然而，在 PTCy 之后，GVHD 与复发率降低无关。