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Prophylaxis and management of graft versus host disease after stem-cell transplantation for haematological malignancies: updated consensus recommendations of the EBMT

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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.

Penack O et al.

Lancet Haematol.

PMID: 32004485

https://www.ncbi.nlm.nih.gov/pubmed/32004485

DOI: 10.1016/S2352-3026(19)30256-X

There is considerable variety in prevention and treatment strategies for GVHD worldwide. To standardize GVHD management, the EBMT gives recommendations that apply to the setting of HLA-identical sibling or unrelated donor transplantation of adult patients with haematologic malignancies.

Based on published evidence, five members of a task force created 38 statements on prophylaxis of GVHD, drug management, treatment of acute and chronic GVHD. Subsequently, the task force created the panel by recruiting 20 experts in the field of GVHD management. An e-mail based two-round Delphi panel approach was used to manage the consensus. Modified NCCN categories for evidence and consensus were applied to the approved statements.

We reached 100% consensus in 29 recommendations and 95% consensus in 9 recommendations. Key new aspects include: a) A broader use of rabbit anti-T-cell globulin is recommended; b) grade II acute GVHD with isolated skin or upper gastrointestinal tract manifestations can be treated with lower steroid doses; c) use of the FAM regimen (Fluticason, Azithromycin and Montelukast) for Bronchiolitis Obliterans Syndrome; and d) addition of newer substances to the available treatment options for steroid-refractory acute and chronic GVHD.

The EBMT proposes to use these recommendations as basis for routine management of GVHD during stem cell transplantation.

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