[The role of MAGIC biomarkers in acute GVHD]

Acute graft-versus-host disease (GVHD) remains a major complication after allogeneic hematopoietic cell transplantation. Although advances in prophylactic strategies have reduced the incidence of severe GVHD, treatment resistance remains a major challenge. Even in patients who initially respond to systemic corticosteroids, adverse events such as GVHD flare, infections, and primary disease relapse are common, partly due to overtreatment in some patients and undertreatment in others. These limitations highlight the need for individualized treatment based on biological risk as well as clinical manifestations. Risk stratification using clinical symptoms and biomarkers has therefore attracted increasing attention. The Mount Sinai Acute GVHD International Consortium (MAGIC) developed a biomarker-based approach using ST2 and Reg3α, and further established integrated models, MAGIC composite scores, which combine biomarker data with clinical severity. These models improve prediction of treatment response and non-relapse mortality, and may inform treatment escalation, de-escalation, and monitoring strategies. Clinical trials incorporating such risk-adapted approaches are expected to improve outcomes in acute GVHD.