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Acute Graft-versus-Host Disease: An Update on New Treatment Options

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Abstract

Acute graft-versus-host disease (GVHD) occurs in approximately 50% of patients and remains a primary driver of non-relapse and transplant-related mortality. The best treatment remains prevention with either in vivo or ex vivo T-cell depletion, with multiple strategies used worldwide based on factors such as institution preference, ability to perform graft manipulation, and ongoing clinical trials. Predicting patients at high risk for developing severe acute GVHD based on clinical and biomarker-based criteria allows for escalation or potential de-escalation of therapy. Modern therapies for treatment of the disease include JAK/STAT pathway inhibitors, which are standard of care in the second-line setting and are being investigated for upfront management of non-severe risk based on biomarkers. Salvage therapies beyond the second-line remain suboptimal. In this review, we will focus on the most clinically used GVHD prevention and treatment strategies, including the accumulating data on JAK inhibitors in both settings.

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  1. Section of BMT & Leukemia, Division of Oncology, Department of Medicine, Washington University in St Louis School of Medicine, St Louis, MO, USA

    Dilan A. Patel, Mallory Crain, Iskra Pusic & Mark A. Schroeder

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DP wrote the manuscript and the table. MC edited the table. MC, IP, and MS provided a conceptual overview for the topics discussed and provided edits on both the manuscript and table.

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DP does not have any conflicts of interest. MC does not have any conflicts. IP has the following conflicts (Advisory board for Syndax Pharmaceuticals and Incyte). MS has the following conflicts (Advisory boards and received honorary or consulting fees: Equillium Inc, GSK, and Incyte).

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Patel, D.A., Crain, M., Pusic, I. et al. Acute Graft-versus-Host Disease: An Update on New Treatment Options. Drugs 83, 893–907 (2023). https://doi.org/10.1007/s40265-023-01889-2

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