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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.
Journal article

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.

  • Penack O Medical Clinic, Department for Haematology, Oncology and Tumorimmunology, Charité Universitätsmedizin Berlin, Berlin, Germany. Electronic address: olaf.penack@charite.de.
  • Marchetti M Division of Hematology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
  • Ruutu T Clinical Research Institute, Helsinki University Hospital, Helsinki, Finland.
  • Aljurf M Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
  • Bacigalupo A Department of Hematology, Fondazione Policlinico Universitario Gemelli Istituto di ricovero e cura a carattere scientifico, Universita' Cattolica del Sacro Cuore, Rome, Italy.
  • Bonifazi F S Orsola-Malpighi University Hospital, Bologna, Italy.
  • Ciceri F Hematology and Bone marrow transplant Unit, Istituto di ricovero e cura a carattere scientifico, San Raffaele Scientific Institute, Via Olgettina Milano, Milan, Italy.
  • Cornelissen J Erasmus Medical center Cancer Institute, University Medical Center Rotterdam, Department of Hematology, Rotterdam, Netherlands.
  • Malladi R Centre for Clinical Haematology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
  • Duarte RF Hematopoietic Transplantation and Hemato-Oncology Section, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
  • Giebel S Maria Sklodowska-Curie Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland.
  • Greinix H Division of Hematology Medical University Graz, Graz, Austria.
  • Holler E Haematology and Oncology Department, Medical Clinic 3, Klinikum der Universität Regensburg, Regensburg, Germany.
  • Lawitschka A St Anna Children's Hospital, Stem Cell Transplant Unit, Medical University Vienna, Vienna, Austria.
  • Mielke S Karolinska Instituet and University Hospital, Department of Laboratory Medicine, Stockholm, Sweden.
  • Mohty M Department of Haematology, Hôpital Saint-Antoine, Universite Pierre and Marie Curie, Institut national de la santé et de la recherche médicale unité mixte de recherche, Paris, France.
  • Arat M Ankara University, School of Medicine, Division of Hematology, Department of Internal Medicine, Ankara, Turkey.
  • Nagler A Hematology and Bone Marrow Transplant Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel.
  • Passweg J Hematology Division, University Hospital Basel, Basel, Switzerland.
  • Schoemans H Department of Hematology, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
  • Socié G Hematology Department, Hopital St Louis, Paris, France.
  • Solano C Hematology Department, Hospital Clínico Universitario-Fundación Investigación del Hospital Clínico Universitario de Valencia, University of Valencia, Valencia, Spain.
  • Vrhovac R Department of Haematology, University Hospital Centre Zagreb, Zagreb, Croatia.
  • Zeiser R Department of Hematology, Oncology, and Stem Cell Transplantation, Faculty of Medicine, Freiburg University Medical Center, Freiburg, Germany.
  • Kröger N University Hospital Eppendorf, Hamburg, Germany.
  • Basak GW Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Poland.
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  • 2020-02-01
Published in:
  • The Lancet. Haematology. - 2020
Disease Management
Drug Monitoring
Drug Resistance
Graft vs Host Disease
Hematologic Neoplasms
Humans
Immunosuppression
Immunosuppressive Agents
Stem Cell Transplantation
Transplantation Conditioning
English Graft-versus-host disease (GVHD) is a major factor contributing to mortality and morbidity after allogeneic stem-cell transplantation. Because of the small number of results from well designed, large-scale, clinical studies there is considerable variability in the prevention and treatment of GVHD worldwide. In 2014, to standardise treatment approaches the European Society of Blood and Marrow Transplantation published recommendations on the management of GVHD in the setting of HLA-identical sibling or unrelated donor transplantation in adult patients with haematological malignancies. Here we update these recommendations including the results of study published after 2014. Evidence was searched in three steps: first, a widespread scan of published trials, meta-analyses, and systematic reviews; second, expert opinion was added for specific issues following several rounds of debate; and third, a refined search to target debated or rapidly updating issues. On the basis of this evidence and the 2014 recommendations, five members of the EBMT Transplant Complications Working Party created 38 statements on GVHD prophylaxis, drug management, and treatment of acute and chronic GVHD. Subsequently, they created the EBMT GVHD management recommendation expert panel by recruiting 20 experts with expertise in GVHD management. An email-based, two-round Delphi panel approach was used to manage the consensus. Modified National Comprehensive Cancer Network categories for evidence and consensus were applied to the approved statements. We reached 100% consensus for 29 recommendations and 95% consensus for nine recommendations. Key updates to these recommendations include a broader use of rabbit anti-T-cell globulin; lower steroid doses for the management of grade 2 acute GVHD with isolated skin or upper gastrointestinal tract manifestations; fluticasone, azithromycin, and montelukast should be used for bronchiolitis obliterans syndrome; and the addition of newer treatment options for resteroid-refractory acute and chronic GVHD. In addition, we discuss specific aspects of GVHD prophylaxis and management in the setting of haploidentical transplantation and in paediatric patients, but no formal recommendations on those procedures have been provided in this Review. The European Society of Blood and Marrow Transplantation proposes to use these recommendations as a basis for the routine management of GVHD during stem-cell transplantation.
Language
  • English
Open access status
closed
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Persistent URL
https://sonar.ch/global/documents/232560
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