Pediatric acute graft-versus-host disease prophylaxis and treatment: surveyed real-life approach reveals dissimilarities compared to published recommendations

Anita Lawitschka*, Giovanna Lucchini, Brigitte Strahm, Jean Hugues Dalle, Adriana Balduzzi, Brenda Gibson, Cristina Diaz De Heredia, Jacek Wachowiak, Arnaud Dalissier, Kim Vettenranta, Isaac Yaniv, Victoria Bordon, Dorothea Bauer, Peter Bader, Roland Meisel, Christina Peters, Selim Corbacioglu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Pediatric allogeneic hematopoietic cell transplantation (HCT) practices differ from those of adults, particularly the heterogeneity of transplantable nonmalignant diseases and the lower incidence of graft-versus-host disease (GVHD). Several guidelines regarding the management of acute (a) GVHD in adult HCT have been published. We aimed to capture the real-life approaches for pediatric aGVHD prophylaxis/treatment, and data from 75/193 (response rate 39%) EBMT centers (26 countries) were included, representing half (48%) of the pediatric EBMT-HCT activity. Results with ≥75% approval from respondents (74/75) for GVHD prophylaxis after myeloablative HCT for malignancies partially contradict published guidelines: Single-agent cyclosporine A (CsA) was used for matched sibling donor HCT in 47%; blood CsA levels were reported lower; the relapse risk in malignant diseases influenced GVHD prophylaxis with early withdrawal of CsA; distinct longer duration of CsA was employed in nonmalignant diseases. Most centers used additional anti-thymocyte globulin for matched unrelated and mismatched donor HCT, but not for matched siblings. Regarding prophylaxis in nonmyeloablative conditioning (mainly for nonmalignant diseases), responses showed broad heterogeneity. High conformity was found for first-line treatment; however, results regarding steroid-refractory aGVHD indicate an earlier diagnosis in children. Our findings highlight the need for standardized pediatric approaches toward aGVHD prophylaxis/treatment differentiated for malignant and nonmalignant underlying diseases.

Original languageEnglish
Pages (from-to)762-772
Number of pages11
JournalTransplant International
Volume33
Issue number7
DOIs
StatePublished - 1 Jul 2020

Keywords

  • acute GVHD
  • hematopoietic cell transplantation
  • pediatrics
  • prophylaxis
  • treatment

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