TY - JOUR
T1 - Prophylaxis and management of graft-versus-host disease after stem-cell transplantation for haematological malignancies
T2 - updated consensus recommendations of the European Society for Blood and Marrow Transplantation
AU - Penack, Olaf
AU - Marchetti, Monia
AU - Aljurf, Mahmoud
AU - Arat, Mutlu
AU - Bonifazi, Francesca
AU - Duarte, Rafael F.
AU - Giebel, Sebastian
AU - Greinix, Hildegard
AU - Hazenberg, Mette D.
AU - Kröger, Nicolaus
AU - Mielke, Stephan
AU - Mohty, Mohamad
AU - Nagler, Arnon
AU - Passweg, Jakob
AU - Patriarca, Francesca
AU - Ruutu, Tapani
AU - Schoemans, Hélène
AU - Solano, Carlos
AU - Vrhovac, Radovan
AU - Wolff, Daniel
AU - Zeiser, Robert
AU - Sureda, Anna
AU - Peric, Zinaida
N1 - Publisher Copyright:
© 2024 Elsevier Ltd
PY - 2024/2
Y1 - 2024/2
N2 - Graft-versus-host disease (GVHD) is a major factor contributing to mortality and morbidity after allogeneic haematopoietic stem-cell transplantation (HSCT). In the last 3 years, there has been regulatory approval of new drugs and considerable change in clinical approaches to prophylaxis and management of GVHD. To standardise treatment approaches, the European Society for Blood and Marrow Transplantation (EBMT) has updated its clinical practice recommendations. We formed a panel of one methodologist and 22 experts in the field of GVHD management. The selection was made on the basis of their role in GVHD management in Europe and their contributions to the field, such as publications, presentations at conferences, and other research. We applied the GRADE process to ten PICO (patient, intervention, comparator, and outcome) questions: evidence was searched for by the panel and graded for each crucial outcome. In two consensus meetings, we discussed the evidence and voted on the wording and strengths of recommendations. Key updates to the recommendations include: (1) primary use of ruxolitinib in steroid-refractory acute GVHD and steroid-refractory chronic GVHD as the new standard of care, (2) use of rabbit anti-T-cell (thymocyte) globulin or post-transplantation cyclophosphamide as standard GVHD prophylaxis in peripheral blood stem-cell transplantations from unrelated donors, and (3) the addition of belumosudil to the available treatment options for steroid-refractory chronic GVHD. The EBMT proposes to use these recommendations as the basis for routine management of GVHD during allogenic HSCT. The current recommendations favour European practice and do not necessarily represent global preferences.
AB - Graft-versus-host disease (GVHD) is a major factor contributing to mortality and morbidity after allogeneic haematopoietic stem-cell transplantation (HSCT). In the last 3 years, there has been regulatory approval of new drugs and considerable change in clinical approaches to prophylaxis and management of GVHD. To standardise treatment approaches, the European Society for Blood and Marrow Transplantation (EBMT) has updated its clinical practice recommendations. We formed a panel of one methodologist and 22 experts in the field of GVHD management. The selection was made on the basis of their role in GVHD management in Europe and their contributions to the field, such as publications, presentations at conferences, and other research. We applied the GRADE process to ten PICO (patient, intervention, comparator, and outcome) questions: evidence was searched for by the panel and graded for each crucial outcome. In two consensus meetings, we discussed the evidence and voted on the wording and strengths of recommendations. Key updates to the recommendations include: (1) primary use of ruxolitinib in steroid-refractory acute GVHD and steroid-refractory chronic GVHD as the new standard of care, (2) use of rabbit anti-T-cell (thymocyte) globulin or post-transplantation cyclophosphamide as standard GVHD prophylaxis in peripheral blood stem-cell transplantations from unrelated donors, and (3) the addition of belumosudil to the available treatment options for steroid-refractory chronic GVHD. The EBMT proposes to use these recommendations as the basis for routine management of GVHD during allogenic HSCT. The current recommendations favour European practice and do not necessarily represent global preferences.
UR - http://www.scopus.com/inward/record.url?scp=85181826048&partnerID=8YFLogxK
U2 - 10.1016/S2352-3026(23)00342-3
DO - 10.1016/S2352-3026(23)00342-3
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C2 - 38184001
AN - SCOPUS:85181826048
SN - 2352-3026
VL - 11
SP - e147-e159
JO - The Lancet Haematology
JF - The Lancet Haematology
IS - 2
ER -