ASTCT consensus recommendations for the clinical management of aGvHD

Evidence-based consensus recommendations from the American Society for Transplantation and Cellular Therapy (ASTCT) for the clinical management of acute graft-versus-host disease (aGvHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) were published in Transplantation and Cellular Therapy by DeFilipp et al. The review aimed to provide treatment recommendations for aGvHD based on available clinical evidence and to identify areas in need of future research. 

Key data: The expert panel endorses the Mount Sinai Acute GvHD International Consortium (MAGIC) grading scheme as the consensus staging system. Validated risk-stratification tools, including the MAGIC Composite Score, Minnesota risk score, and Manhattan risk system, are recommended for patients with newly diagnosed aGvHD but are not yet validated to direct treatment decisions. Initial corticosteroid dosing at 2 mg/kg/day remains the recommended first-line systemic therapy, though lower doses may be considered for Stage I skin and/or upper gastrointestinal (GI) aGvHD. Systemic therapies are not recommended as alternatives to corticosteroids in first-line treatment. In the second-line setting, ruxolitinib is the consensus standard, with remestemcel-L-rknd recognized as an alternative for pediatric patients. No consensus third-line therapy is endorsed. 

Key learning: Updated ASTCT consensus recommendations reinforce corticosteroids as first-line therapy for aGvHD and endorse ruxolitinib as the second-line standard, while highlighting the unmet need for validated risk-adapted treatment strategies and effective third-line options.