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Updated consensus recommendations from the EBMT on prophylaxis and management of post-transplant graft-versus-host disease

Mar 5, 2024
Learning objective: After reading this article, learners will be able to discuss the EBMT recommendations for the prophylaxis and management of graft-versus-host disease after hematopoietic stem cell transplantation.

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The European Society for Blood and Marrow Transplantation (EBMT) last published its clinical practice recommendation for the management of graft-versus-host disease (GvHD) in 2020, which was previously covered on the GvHD Hub here. Following recent drug approvals, pivotal data from trials, and changes in GvHD prevention strategies, there has been a need for the clinical practice recommendations to be updated in order to standardize the treatment approach for GvHD.1

Below, we summarize recommendations published by Penack et al.1 in The Lancet Haematology on the prophylaxis and management of GvHD after stem cell transplantation for hematological malignancies: updated consensus recommendations of the EBMT.1


A panel consisting of 22 experts in the field of GvHD management, a Chair, and a methodologist used the “grading of recommendations, assessment, development, and evaluations” (GRADE) process on ten “patient, intervention, comparator, and outcome” (PICO) questions to produce recommendations. The evidence was graded by a modified National Comprehensive Cancer Network (NCCN) classification of evidence and consensus.

Updated recommendations1

Key updates to the recommendations, summarized in Figure 1, relate to the use of post-transplantation cyclophosphamide (PTCy) for GvHD prophylaxis, the use of ruxolitinib as a standard of care treatment for GvHD, and the addition of new GvHD treatment options.

Figure 1. Updated EMBT recommendations on the prophylaxis and management of post-transplant GvHD* 

aGvHD, acute graft-versus-host disease; cGvHD, chronic graft-versus-host disease; EBMT, European Society for Blood and Marrow Transplantation; HSCT, hematopoietic stem cell transplantation; MMUD, mismatched unrelated donors; MUD, matched unrelated donor; NCCN, National Comprehensive Cancer Network; PTCy, post-transplantation cyclophosphamide; rATG, rabbit anti-T-cell globulin; SR-aGvHD, steroid-refractory acute graft-versus-host disease; SR-cGvHD, steroid-refractory chronic graft-versus-host disease.
*Adapted from Penack et al.1


Key learnings1

  • The EBMT suggests the use of the updated recommendations as the basis for the routine management of GvHD during allogeneic HSCT.
  • These recommendations favor European practice and may not align with global preferences.

  1. Penack O, Marchetti M, Ruutu T, et al. Prophylaxis and management of graft versus host disease after stem-cell transplantation for haematological malignancies: updated consensus recommendations of European Society for Blood and Marrow Transplantation. Lancet Haematol. 2024;11:e147-e159. DOI:10.1016/S2352-3026(23)00342-3.


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