TY - JOUR
T1 - Prophylaxis and management of graft versus host disease after stem-cell transplantation for haematological malignancies
T2 - updated consensus recommendations of the European Society for Blood and Marrow Transplantation
AU - Penack, Olaf
AU - Marchetti, Monia
AU - Ruutu, Tapani
AU - Aljurf, Mahmoud
AU - Bacigalupo, Andrea
AU - Bonifazi, Francesca
AU - Ciceri, Fabio
AU - Cornelissen, Jan
AU - Malladi, Ram
AU - Duarte, Rafael F.
AU - Giebel, Sebastian
AU - Greinix, Hildegard
AU - Holler, Ernst
AU - Lawitschka, Anita
AU - Mielke, Stephan
AU - Mohty, Mohamad
AU - Arat, Mutlu
AU - Nagler, Arnon
AU - Passweg, Jakob
AU - Schoemans, Hélène
AU - Socié, Gerard
AU - Solano, Carlos
AU - Vrhovac, Radovan
AU - Zeiser, Robert
AU - Kröger, Nicolaus
AU - Basak, Grzegorz W.
N1 - Funding Information:
FB participated in advisory boards and has received speaker fees from Neovii, Incyte, and Novartis. RD has received personal fees from Cidara Therapeutics, Gilead Sciences, Incyte, Jazz Pharmaceuticals, and Medac; and grants and personal fees from Merck Sharp & Dohme, Omeros Corporation, and Therakos. HG has received honoraria for presentations in scientific meetings from Therakos, Novartis, Amgen, Roche, and Cellgene; and has received honoraria for participation in advisory boards from Therakos, Novartis, and Cellgene. SG has received personal fees from Sanofi and Novartis. EH has received honoraria as a speaker and funding for meetings from Neovii. NK has received grants and personal fees from Neovii, Novartis, Therakos, Celgene, Sanofi, and Kiadis; and research grants from Neovii, Riemser, and Novartis. SM has received travel support from Cellex, Gilead, Merck Sharpe & Dohme, Celgene, Kiadis, and Miltenyi; speakers fees from Miltenyi, Jazz, Kiadis, Celgene, and Cellex; and honoraria for consultancy from Novartis and Merck Sharpe and Dohme. MMo has received grants and personal fees from Janssen, Sanofi, and Jazz Pharmaceuticals; personal fees from Celgene, Amgen, Bristol Meyers Squibb, and Takeda; and grants from Roche. OP has received grants and personal fees from Incyte, Neovii, Gilead, Merck Sharpe and Dohme, Omeros, Sobi, Takeda, and Jazz Pharmaceuticals. CS has received lectures honoraria from Genzyme Sanofi, Janssen, and Neovii. HS has received travel expenses from Celgene, Abbvie, and Incyte; is part of the advisory boards for Incyte; and has received speaker's fees from Novartis, Incyte, Jazz Pharmaceuticals, and Takeda. RV has received lecture honoraria from Novartis; and personal fees from Novartis, Mallinckroth, and Incyte. All other authors report no competing interests.
Funding Information:
EH thanks Deutsche Forschungsgemeinschaft (TR221, B13 and CRC 1371, P4) and José Carreras Leukämie-Stiftung (GvHD 01/2019). OP thanks Deutsche Forschungsgemeinschaft (PE1450/7–1), Deutsche Krebshilfe (70111519), and José Carreras Leukämie-Stiftung (11R2016; 03R2019). RZ thanks Deutsche Forschungsgemeinschaft, Germany, TRR167, project B06, SFB1160 TP B09, ERC Consolidator grant ( 681012 GvHDCure). The authors thank Prof Daniel Wolff, Regensburg University, Regensburg, Germany, for his critical review of the Review.
Funding Information:
EH thanks Deutsche Forschungsgemeinschaft (TR221, B13 and CRC 1371, P4) and Jos? Carreras Leuk?mie-Stiftung (GvHD 01/2019). OP thanks Deutsche Forschungsgemeinschaft (PE1450/7?1), Deutsche Krebshilfe (70111519), and Jos? Carreras Leuk?mie-Stiftung (11R2016; 03R2019). RZ thanks Deutsche Forschungsgemeinschaft, Germany, TRR167, project B06, SFB1160 TP B09, ERC Consolidator grant (681012 GvHDCure). The authors thank Prof Daniel Wolff, Regensburg University, Regensburg, Germany, for his critical review of the Review.
Publisher Copyright:
© 2020 Elsevier Ltd
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/2
Y1 - 2020/2
N2 - 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.
AB - 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.
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U2 - 10.1016/S2352-3026(19)30256-X
DO - 10.1016/S2352-3026(19)30256-X
M3 - Review article
C2 - 32004485
AN - SCOPUS:85078222482
VL - 7
SP - e157-e167
JO - The Lancet Haematology
JF - The Lancet Haematology
SN - 2352-3026
IS - 2
ER -