Prophylaxis and management of graft-versus-host disease after stem-cell transplantation for haematological malignancies: updated consensus recommendations of the European Society for Blood and Marrow Transplantation

Olaf Penack*, Monia Marchetti, Mahmoud Aljurf, Mutlu Arat, Francesca Bonifazi, Rafael F. Duarte, Sebastian Giebel, Hildegard Greinix, Mette D. Hazenberg, Nicolaus Kröger, Stephan Mielke, Mohamad Mohty, Arnon Nagler, Jakob Passweg, Francesca Patriarca, Tapani Ruutu, Hélène Schoemans, Carlos Solano, Radovan Vrhovac, Daniel WolffRobert Zeiser, Anna Sureda, Zinaida Peric

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)e147-e159
JournalThe Lancet Haematology
Volume11
Issue number2
DOIs
StatePublished - Feb 2024
Externally publishedYes

Funding

FundersFunder number
Stiftung Charité Berlin Institute of HealthBIH_PRO_549
Deutsche ForschungsgemeinschaftPE 1450/7–1, PE 1450/10–1, PE 1450/9–1
José Carreras Leukämie-Stiftung23R/2021, 3R/2019
Deutsche Krebshilfe70113519

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