Prophylaxis and treatment of GVHD: EBMT–ELN working group recommendations for a standardized practice

Abstract

working group of the European Group for Blood and Marrow Transplantation (EBMT) and the European LeukemiaNet (ELN) GVHD remains the major impediment to broader application of allogeneic haematopoietic SCT. It can be prevented completely, but at the expense of other complications, rejection, relapse or delayed immune reconstitution. No optimal prevention or treatment method has been defined. This is reflected by enormous heterogeneity in approaches in Europe. Retrospective comparisons between different policies, although warranted, do not give definite answers. In order to improve the present situation, an European Group for Blood and Marrow Transplantation and the European LeukemiaNet working group has developed in a Delphilike approach recommendations for prophylaxis and treatment of GVHD in the most common allogeneic transplant setting, transplantation from an HLA-identical sibling or unrelated donor for standard risk malignant disease. The working group proposes these guidelines to be adopted as routine standard in transplantation centres and to be used as comparator in systematic studies evaluating the advantages and disadvantages of practices differing from these recommendations.

Numerical impairment of nestin+ bone marrow niches in acute GvHD after allogeneic hematopoietic stem cell transplantation for AML

“…3 The primary target tissues of these T cells are host epithelia in the skin, liver and intestine. 3,4 There is increasing evidence that the bone marrow (BM) stem cell niche and endothelial cells are also targets of GvHD. [5][6][7][8][9][10] Moreover, hematopoietic dysfunction, especially thrombocytopenia, is associated with GvHD.…”

Attenuation of graft‐versus‐host‐disease in NOD scid IL‐2Rγ−/− (NSG) mice by ex vivo modulation of human CD4+ T cells

“…For a broader application of allogeneic HSCT (e.g., in autoimmune diseases), GvHD is the major obstacle (2,15). It can be completely prevented by the respective immunosuppressive therapy but at the expense of serious complications such as graft rejection, delayed immune reconstitution, or tumor relapse due to an interference with the beneficial Graft-versus-Leukemia (GvL) effect (2,15,16).…”

Cyclosporine Plus Methotrexate or Cyclosporine Plus Mycophenolate Mofetil as Graft Versus Host Disease Prophylaxis in Acute Leukemia Transplant: Comparison of Toxicity, Engraftment Kinetics and Transplant Outcome

“…CsA combined with either MTX or MMF is the most widely used immunosuppressive drug [5,6,8]. Recently, the European Group for Blood and Marrow Transplantation (EBMT) and European Leukemia Net have proposed recommendations for GVHD prophylaxis in allogeneic HSCT [18]. They recommend CsA?MTX as GVHD prophylaxis for patients receiving myeloablative conditioning and CsA?MMF for patients receiving reduced intensity conditioning.…”