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

TY - JOUR

T1 - 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

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 - Copyright © 2024 Elsevier Ltd. All rights reserved.

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.

KW - Humans

KW - Rabbits

KW - Animals

KW - Bone Marrow

KW - Consensus

KW - Neoplasm Recurrence, Local/drug therapy

KW - Hematopoietic Stem Cell Transplantation/adverse effects

KW - Graft vs Host Disease/etiology

KW - Peripheral Blood Stem Cell Transplantation

KW - Cyclophosphamide/therapeutic use

KW - Hematologic Neoplasms/therapy

KW - Steroids

U2 - 10.1016/S2352-3026(23)00342-3

DO - 10.1016/S2352-3026(23)00342-3

M3 - SCORING: Review article

C2 - 38184001

VL - 11

SP - e147-e159

JO - LANCET HAEMATOL

JF - LANCET HAEMATOL

SN - 2352-3026

IS - 2

ER -