Acute GVHD: think before you treat.

Area of Science:

• Hematology
• Immunology
• Oncology

Background:

• Acute graft-versus-host disease (aGVHD) is a complex multisystem complication following allogeneic stem cell transplantation.
• Advances in risk classification and understanding of pathophysiology are refining aGVHD management.
• Current treatment strategies are evolving, necessitating a review of contemporary approaches.

Observation:

• Risk stratification systems for aGVHD have improved, guiding clinical decision-making.
• Ruxolitinib is the first FDA-approved therapy for steroid-refractory aGVHD (SR-aGVHD).
• Steroid-dependent aGVHD presents distinct long-term challenges in approximately one-third of patients.

Findings:

• Contemporary risk stratification and initial treatment protocols are being updated.
• The approval of ruxolitinib marks a significant advancement in treating SR-aGVHD.
• Steroid-dependent aGVHD requires specific evaluation and management strategies distinct from chronic GVHD.

Implications:

• Future clinical trials aim to develop steroid-sparing treatments for high-response likelihood patients.
• Research is exploring methods to enhance tissue repair and address dysbiosis in non-responsive cases.
• Optimized management of aGVHD, including SR-aGVHD and steroid-dependent forms, is crucial for patient outcomes.