The impacts of graft‐versus‐host disease (GVHD) and graft‐versus‐leukemia (GVL) effect might differ depending on minimal residual disease (MRD). Therefore, we examined 1,022 recipients who underwent their first allogeneic hematopoietic stem cell transplantation (HSCT) for Philadelphia chromosome‐positive acute lymphoblastic leukemia (Ph‐positive ALL) in first complete remission. MRD status at HSCT was negative in 791 (77·4%) and positive in 231 (22·6%). The impact of GVHD as a time‐dependent covariate on transplant outcomes were analyzed while adjusting for other possible variables. Mild acute GVHD [hazard ratio (HR), 0·90; 95% confidence interval (CI), 0·70–1·16; P  = 0·901] and chronic GVHD (HR, 0·82, 95% CI, 0·58–1·14; P  = 0·238) were not significantly associated with overall mortality, whereas severe acute GVHD (HR, 2·26, 95% CI, 1·64–3·11; P  < 0·001) resulted in inferior overall survival due to high non‐relapse mortality. Moreover, even in the subgroup analyses stratified according to MRD status, acute and chronic GVHD were not significantly associated with better overall survival. Therefore, less intensive GVHD prophylaxis to achieve a GVL effect is not recommended for Ph‐positive ALL.

中文翻译：

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费城染色体阳性急性淋巴细胞白血病中基于最小残留病的移植物抗宿主病和移植物抗白血病作用的影响。

移植物抗宿主病（GVHD）和移植物抗白血病（GVL）的影响可能因最小残留疾病（MRD）而异。因此，我们检查了1,022名接受首次异体造血干细胞移植（HSCT）的接受者，这些接受者在首次完全缓解后就发生了费城染色体阳性的急性淋巴细胞白血病（Ph阳性的ALL）。HSCT的MRD状态为阴性（791（77·4％））和阳性（231）（22·6％）。在调整其他可能变量的同时，分析了GVHD作为随时间变化的协变量对移植结果的影响。轻度急性GVHD [危险比（HR），0·90；95％置信区间（CI），0·70-1·16；P  = 0·901]和慢性GVHD（HR，0·82，95％CI，0·58-1·14；P = 0·238）与总死亡率无显着相关性，而严重的急性GVHD（HR，2·26、95％CI，1·64-3·11；P  <0·001）由于高死亡率而导致总生存期较差非复发死亡率。此外，即使在根据MRD状态进行分层的亚组分析中，急性和慢性GVHD也不与更好的总体生存率显着相关。因此，不建议对Ph阳性ALL进行强度较低的GVHD预防，以达到GVL效果。