Acute graft-versus-host disease

Adriana Mello Rodrigues; Rita de Cassia Barbosa da Silva Tavares; Carla Nolasco Monteiro Breviglieri; Marcia de Matos Silva; Roseane Vasconcelos Gouveia; Virgínio Climaco de Araújo Fernandes Junior; Luis Fernando Bouzas

doi:10.46765/2675-374X.2025v6n1e306

Acute graft-versus-host disease

Authors

Adriana Mello Rodrigues Hospital Pequeno Príncipe – Curitiba (PR), Brazil|Universidade Federal do Paraná – Hospital de Clínicas – Curitiba (PR), Brazil. https://orcid.org/0000-0002-1971-9299
Rita de Cassia Barbosa da Silva Tavares Instituto Nacional do Câncer – Rio de Janeiro (RJ), Brazil. https://orcid.org/0000-0002-9050-7918
Carla Nolasco Monteiro Breviglieri Hospital Samaritano de São Paulo – São Paulo (SP), Brazil. https://orcid.org/0000-0002-6089-5526
Marcia de Matos Silva Clínica Ceda – Dermatologia – Rio de Janeiro (RJ), Brazil. https://orcid.org/0000-0003-2038-5158
Roseane Vasconcelos Gouveia Hospital Samaritano de São Paulo – São Paulo (SP), Brazil|Universidade Federal de São Paulo – Grupo de Apoio ao Adolescente e à Criança com Câncer – São Paulo (SP), Brazil. https://orcid.org/0000-0002-9370-7878
Virgínio Climaco de Araújo Fernandes Junior Grupo de Pesquisa e Assistência ao Câncer Infantil – Sorocaba (SP), Brazil. https://orcid.org/0009-0006-6175-5062
Luis Fernando Bouzas Hospital Unimed – Volta Redonda (RJ), Brazil|Medcel Medicina Celular – Rio de Janeiro (RJ), Brazil. https://orcid.org/0000-0002-6267-9448

DOI:

https://doi.org/10.46765/2675-374X.2025v6n1e306

Keywords:

Hematopoietic Stem Cell Transplantation, Graft vs Host Disease, Risk Factors

Abstract

Despite current advances in graft-versus-host disease (GvHD) prophylaxis, it remains one of the leading causes of morbidity and mortality after hematopoietic cell transplantation (HCT). The first-line therapy for acute GvHD is systemic corticosteroids, but about half of affected patients needs a second-line treatment. Ruxolitinib has been recommended for steroid-refractory GvHD, but treatment costs and adverse events such as cytopenias and infections are limitations. The main second-line alternatives for children are: basilixmab, an anti-interleukin-2-receptor monoclonal antibody, which showed good responses in skin and gut manifestations; extracorporeal photopheresis, treatment that preserves graft-versus-leukemia effect due to its steroid sparing and immunomodulatory actions, and mesenchymal stem cells, another non-pharmacological strategy that can be combined with the options mentioned before in severe acute GvHD. Novel therapeutical agents are emerging, but their efficacy and safety need further investigation in pediatric patients. We reviewed clinical studies and published recommendations on pediatric acute GvHD that were presented in debate rounds with GvHD experts of the Pediatric Group of the Brazilian Society for Cellular Therapy and Bone Marrow Transplantation. The goal of this consensus is to standardize the prophylaxis, diagnosis, grading, and treatment of acute GvHD among Brazilian pediatric HCT centers, to improve post-transplant outcomes.

References

1. Wölfl M, Qayed M, Benitez Carabante MI, Sykora T, Bonig H, Lawitschka A, Diaz-de-Heredia C. Current prophylaxis and treatment approaches for acute graft-versus-host disease in haematopoietic stem cell transplantation for children with acute lymphoblastic leukaemia. Front Pediatr. 2022;9:784377. https://doi.org/10.3389/fped.2021.784377 DOI: https://doi.org/10.3389/fped.2021.784377

2. Qayed M, Wang T, Hemmer MT, Spellman S, Arora M, Couriel D, Alousi A, Pidala J, Abdel-Azim H, Aljurf M, Ayas M, Bitan M, Cairo M, Choi SW, Dandoy C, Delgado D, Gale RP, Hale G, Frangoul H, Kamble RT, Kharfan-Dabaja M, Lehman L, Levine J, MacMillan M, Marks DI, Nishihori T, Olsson RF, Hematti P, Ringden O, Saad A, Satwani P, Savani BN, Schultz KR, Seo S, Shenoy S, Waller EK, Yu L, Horowitz MM, Horan J. Influence of age on acute and chronic GVHD in children undergoing HLA-identical sibling bone marrow transplantation for acute leukemia: implications for prophylaxis. Biol Blood Marrow Transplant. 2018;24(3):521–8. https://doi.org/10.1016/j.bbmt.2017.11.004 DOI: https://doi.org/10.1016/j.bbmt.2017.11.004

3. Penack O, Marchetti M, Aljurf M, Arat M, Bonifazi F, Duarte RF, Giebel S, Greinix H, Hazenberg MD, Kröger N, Mielke S, Mohty M, Nagler A, Passweg J, Patriarca F, Ruutu T, Schoemans H, Solano C, Vrhovac R, Wolff D, Zeiser R, Sureda A, Peric Z. Prophylaxis and management of graft-versus-host disease after stem-cell transplantation for haematological malignancies: updated consensus recommendations of the European Society for Blood and Marrow Transplantation. Lancet Haematol. 2024;11(2):e147–59. https://doi.org/10.1016/s2352-3026(23)00342-3 DOI: https://doi.org/10.1016/S2352-3026(23)00342-3

4. Olivieri A, Mancini G. Current approaches for the prevention and treatment of acute and chronic GVHD. Cells. 2024;13(18):1524. https://doi.org/10.3390/cells13181524 DOI: https://doi.org/10.3390/cells13181524

5. Lawitschka A, Lucchini G, Strahm B, Dalle JH, Balduzzi A, Gibson B, Diaz De Heredia C, Wachowiak J, Dalissier A, Vettenranta K, Yaniv I, Bordon V, Bauer D, Bader P, Meisel R, Peters C, Corbacioglu S; European Society for Blood, Marrow Transplantation (EBMT) Pediatric Diseases Working Party. Pediatric acute graft‐versushost disease prophylaxis and treatment: surveyed real‐life approach reveals dissimilarities compared to published recommendations. Transpl Int. 2020;33(7):762–72. https://doi.org/10.1111/tri.13601 DOI: https://doi.org/10.1111/tri.13601

6. Bader P, Salzmann-Manrique E, Balduzzi A, Dalle JH, Woolfrey AE, Bar M, Verneris MR, Borowitz MJ, Shah NN, Gossai N, Shaw PJ, Chen AR, Schultz KR, Kreyenberg H, Di Maio L, Cazzaniga G, Eckert C, van der Velden VHJ, Sutton R, Lankester A, Peters C, Klingebiel TE, Willasch AM, Grupp SA, Pulsipher MA. More precisely defining risk peri-HCT in pediatric ALL: pre- vs post-MRD measures, serial positivity, and risk modeling. Blood Adv. 2019;3(21):3393–405. https://doi.org/10.1182/bloodadvances.2019000449 DOI: https://doi.org/10.1182/bloodadvances.2019000449

7. Pulsipher MA, Langholz B, Wall DA, Schultz KR, Bunin N, Carroll WL, Raetz E, Gardner S, Gastier-Foster JM, Howrie D, Goyal RK, Douglas JG, Borowitz M, Barnes Y, Teachey DT, Taylor C, Grupp SA. The addition of sirolimus to tacrolimus/methotrexate GVHD prophylaxis in children with ALL: a phase 3 Children’s Oncology Group/Pediatric Blood and Marrow Transplant Consortium trial. Blood. 2014;123(13):2017–25. https://doi.org/10.1182/blood-2013-10-534297 DOI: https://doi.org/10.1182/blood-2013-10-534297

8. Peters C, Dalle JH, Locatelli F, Poetschger U, Sedlacek P, Buechner J, Shaw PJ, Staciuk R, Ifversen M, Pichler H, Vettenranta K, Svec P, Aleinikova O, Stein J, Güngör T, Toporski J, Truong TH, Diaz-de-Heredia C, Bierings M, Ariffin H, Essa M, Burkhardt B, Schultz K, Meisel R, Lankester A, Ansari M, Schrappe M; IBFM Study Group; von Stackelberg A; IntReALL Study Group; Balduzzi A; I-BFM SCT Study Group; Corbacioglu S; EBMT Paediatric Diseases Working Party; Bader P. Total body irradiation or chemotherapy conditioning in childhood ALL: a multinational, randomized, noninferiority phase III study. J Clin Oncol. 2021;39(4): 295–307. https://doi.org/10.1200/jco.20.02529 DOI: https://doi.org/10.1200/JCO.20.02529

9. Jagasia MH, Greinix HT, Arora M, Williams KM, Wolff D, Cowen EW, Palmer J, Weisdorf D, Treister NS, Cheng GS, Kerr H, Stratton P, Duarte RF, McDonald GB, Inamoto Y, Vigorito A, Arai S, Datiles MB, Jacobsohn D, Heller T, Kitko CL, Mitchell SA, Martin PJ, Shulman H, Wu RS, Cutler CS, Vogelsang GB, Lee SJ, Pavletic SZ, Flowers ME. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group Report. Biol Blood Marrow Transplant. 2015;21(3):389–401.e1. https://doi.org/10.1016/j.bbmt.2014.12.001 DOI: https://doi.org/10.1016/j.bbmt.2014.12.001

10. Malard F, Holler E, Sandmaier BM, Huang H, Mohty M. Acute graft-versus-host disease. Nat Rev Dis Primer. 2023; 9(1):27. https://doi.org/10.1038/s41572-023-00438-1 DOI: https://doi.org/10.1038/s41572-023-00438-1

11. Harris AC, Young R, Devine S, Hogan WJ, Ayuk F, Bunworasate U, Chanswangphuwana C, Efebera YA, Holler E, Litzow M, Ordemann R, Qayed M, Renteria AS, Reshef R, Wölfl M, Chen YB, Goldstein S, Jagasia M, Locatelli F, Mielke S, Porter D, Schechter T, Shekhovtsova Z, Ferrara JL, Levine JE. International, multicenter standardization of acute graft-versus-host disease clinical data collection: a report from the Mount Sinai Acute GVHD International Consortium. Biol Blood Marrow Transplant. 2016;22(1):4–10. https://doi.org/10.1016/j.bbmt.2015.09.001 DOI: https://doi.org/10.1016/j.bbmt.2015.09.001

12. Zeiser R, Teshima T. Nonclassical manifestations of acute GVHD. Blood. 2021;138(22):2165–72. https://doi.org/10.1182/blood.2021012431 DOI: https://doi.org/10.1182/blood.2021012431

13. Haimes H, Morley KW, Song H, Okhovat J, Schmidt B, Huang JT. Impact of skin biopsy on the management of acute graft‐versus‐host disease in a pediatric population. Pediatr Dermatol. 2019;36(4):455–9. https://doi.org/10.1111/pde.13840 DOI: https://doi.org/10.1111/pde.13840

14. Ghimire S, Weber D, Mavin E, Wang XN, Dickinson AM, Holler E. Pathophysiology of GvHD and other HSCT related major complications. Front Immunol. 2017;8:79. https://doi.org/10.3389/fimmu.2017.00079 DOI: https://doi.org/10.3389/fimmu.2017.00079

15. Rostagno E, Campanati A, Mordini N, Cannici C, Cioce M, De Cecco V, Samarani E, Foà R, Olivieri A, Botti S. Phototherapy and topical treatments for cutaneous graft vs. host disease in haematopoietic stem cell transplantation patients: a scoping review. J Eur Acad Dermatol Venereol. 2022;36(7):1003–15. https://doi.org/10.1111/jdv.18074 DOI: https://doi.org/10.1111/jdv.18074

16. Mielcarek M, Furlong T, Storer BE, Green ML, McDonald GB, Carpenter PA, Flowers ME, Storb R, Boeckh M, Martin PJ. Effectiveness and safety of lower dose prednisone for initial treatment of acute graft-versushost disease: a randomized controlled trial. Haematologica. 2015;100(6):842–8. https://doi.org/10.3324/haematol.2014.118471 DOI: https://doi.org/10.3324/haematol.2014.118471

17. Dou L, Zhao Y, Yang J, Deng L, Wang N, Zhang X, Liu Q, Yang Y, Wei Z, Wang F, Jiao Y, Li F, Luan S, Hu L, Gao S, Liu C, Liu X, Yan J, Zhang X, Zhou F, Lu P, Liu D. Ruxolitinib plus steroids for acute graft versus host disease: a multicenter, randomized, phase 3 trial. Signal Transduct Target Ther. 2024;9(1):288. https://doi.org/10.1038/s41392-024-01987-x DOI: https://doi.org/10.1038/s41392-024-01987-x

18. Toubai T. Ruxolitinib REACHes FOR children with GVHD. Blood. 2024;144(20):2069–70. https://doi.org/10.1182/blood.2024026120 DOI: https://doi.org/10.1182/blood.2024026120

19. Zeiser R, von Bubnoff N, Butler J, Mohty M, Niederwieser D, Or R, Szer J, Wagner EM, Zuckerman T, Mahuzier B, Xu J, Wilke C, Gandhi KK, Socié G; REACH2 Trial Group. Ruxolitinib for Glucocorticoid Refractory Acute Graft-versus-Host Disease. N Engl J Med. 2020;382(19):1800–10. https://doi.org/10.1056/nejmoa1917635 DOI: https://doi.org/10.1056/NEJMoa1917635

20. Palandri F, Tiribelli M, Breccia M, Bartoletti D, Elli EM, Benevolo G, Martino B, Cavazzini F, Tieghi A, Iurlo A, Pugliese N, Crugnola M, Binotto G, Caocci G, Auteri G, Cattaneo D, Catani L, Stella R, Scaffidi L, Polverelli N, Micucci G, Masselli E, Bosi C, Heidel FH, Latagliata R, Pane F, Cuneo A, Krampera M, Semenzato G, Lemoli RM, Vianelli N, Cavo M, Palumbo GA, Bonifacio M. Ruxolitinib rechallenge in resistant/intolerant MF patients: frequency, therapeutic effects, and impact on outcome. Blood. 2020;136(Suppl. 1):49–50. https://doi.org/10.1182/blood-2020-139197 DOI: https://doi.org/10.1182/blood-2020-139197

21. Funke VAM, De Medeiros CR, Setúbal DC, Ruiz J, Bitencourt MA, Bonfim CM, Neto JZ, Pasquini R. Therapy for severe refractory acute graft-versus-host disease with basiliximab, a selective interleukin-2 receptor antagonist. Bone Marrow Transplant. 2006;37(10):961–5. https://doi.org/10.1038/sj.bmt.1705306 DOI: https://doi.org/10.1038/sj.bmt.1705306

22. Wang JZ, Liu KY, Xu LP, Liu DH, Han W, Chen H, Chen YH, Zhang XH, Zhao T, Wang Y, Huang XJ. Basiliximab for the treatment of steroid-refractory acute graft-versus-host disease after unmanipulated HLAmismatched/haploidentical hematopoietic stem cell transplantation. Transplant Proc. 2011;43(5):1928–33. https://doi.org/10.1016/j.transproceed.2011.03.044 DOI: https://doi.org/10.1016/j.transproceed.2011.03.044

23. Jiang XY, Zhang XH, Xu LP, Wang Y, Yan CH, Chen H, Chen YH, Han W, Wang FR, Wang JZ, Sun YQ, Mo XD, Huang XJ. Basiliximab treatment for patients with steroid-refractory acute graft-versus-host disease following matched sibling donor hematopoietic stem cell transplantation. Cell Transplant. 2024; 33: 09636897241257568. https://doi.org/10.1177/09636897241257568 DOI: https://doi.org/10.1177/09636897241257568

24. Shen MZ, Li JX, Zhang XH, Xu LP, Wang Y, Liu KY, Huang XJ, Hong SD, Mo XD. Meta-analysis of interleukin-2 receptor antagonists as the treatment for steroid-refractory acute graft-versus-host disease. Front Immunol. 2021;12:749266. https://doi.org/10.3389/fimmu.2021.749266 DOI: https://doi.org/10.3389/fimmu.2021.749266

25. Feldstein JV, Bolaños-Meade J, Anders VL, Abuav R. Narrowband ultraviolet B phototherapy for the treatment of steroid-refractory and steroid-dependent acute graft-versus-host disease of the skin. J Am Acad Dermatol. 2011;65(4):733–8. https://doi.org/10.1016/j.jaad.2010.08.006 DOI: https://doi.org/10.1016/j.jaad.2010.08.006

26. Sokolova A, Lee A, D Smith S. The safety and efficacy of narrow band ultraviolet B treatment in dermatology: a review. Am J Clin Dermatol. 2015; 16(6): 501–31. https://doi.org/10.1007/s40257-015-0151-7 DOI: https://doi.org/10.1007/s40257-015-0151-7

27. Buder K, Zirngibl M, Bapistella S, Meerpohl JJ, Strahm B, Bassler D, Weitz M. Extracorporeal photopheresis versus standard treatment for acute graft-versus-host disease after haematopoietic stem cell transplantation in children and adolescents. Cochrane Childhood Cancer Group, organizador. Cochrane Database Syst Rev 2022;(9):CD009759. http://doi.org/10.1002/14651858.CD009759.pub4 DOI: https://doi.org/10.1002/14651858.CD009759.pub4

28. Asensi Cantó P, Sanz Caballer J, Solves Alcaína P, De La Rubia Comos J, Gómez Seguí I. Extracorporeal photopheresis in graft-versus-host disease. Transplant Cell Ther. 2023;29(9):556–66. https://doi.org/10.1016/j.jtct.2023.07.001 DOI: https://doi.org/10.1016/j.jtct.2023.07.001

29. Penack O, Peczynski C, Boreland W, Lemaitre J, Reinhardt HC, Afanasyeva K, Avenoso D, Holderried TAW, Kornblit BT, Gavriilaki E, Martinez C, Chiusolo P, Mico MC, Daguenet E, Wichert S, Ozdogu H, Piekarska A, Kinsella F, Basak GW, Schoemans H, Koenecke C, Moiseev I, Peric Z. ECP versus ruxolitinib in steroidrefractory chronic GVHD – a retrospective study by the EBMT transplant complications working party. Bone Marrow Transplant. 2024;59(3):380–6. https://doi.org/10.1038/s41409-023-02174-2 DOI: https://doi.org/10.1038/s41409-023-02174-2

30. Amorin B, Alegretti AP, Valim V, Pezzi A, Laureano AM, da Silva MA, Wieck A, Silla L. Mesenchymal stem cell therapy and acute graft-versus-host disease: a review. Hum Cell. 2014;27(4):137–50. https://doi.org/10.1007/s13577-014-0095-x DOI: https://doi.org/10.1007/s13577-014-0095-x

31. Kelly K, Rasko JEJ. Mesenchymal stromal cells for the treatment of graft versus host disease. Front Immunol. 2021;12:761616. https://doi.org/10.3389/fimmu.2021.761616 DOI: https://doi.org/10.3389/fimmu.2021.761616

32. Kadri N, Amu S, Iacobaeus E, Boberg E, Le Blanc K. Current perspectives on mesenchymal stromal cell therapy for graft versus host disease. Cell Mol Immunol. 2023;20(6):613–25. https://doi.org/10.1038/s41423-023-01022-z DOI: https://doi.org/10.1038/s41423-023-01022-z

33. Giannoni L, Morin F, Robin M, Peyneau M, Schlageter MH, Desmier D, Pagliuca S, Sutra Del Galy A, Sicre de Fontbrune F, Xhaard A, Dhedin N, Moins-Teisserenc H, Peffault de Latour R, Socié G, Michonneau D. Human-derived α1-antitrypsin is still efficacious in heavily pretreated patients with steroid-resistant gastrointestinal graft-versus-host disease. Biol Blood Marrow Transplant. 2020; 26(9):1620–6. https://doi.org/10.1016/j.bbmt.2020.05.014 DOI: https://doi.org/10.1016/j.bbmt.2020.05.014

34. Magenau JM, Goldstein SC, Peltier D, Soiffer RJ, Braun T, Pawarode A, Riwes MM, Kennel M, Antin JH, Cutler CS, Ho VT, Alyea EP 3rd, Parkin BL, Yanik GA, Choi SW, Lewis EC, Dinarello CA, Koreth J, Reddy P. α1-Antitrypsin infusion for treatment of steroid-resistant acute graft-versus-host disease. Blood. 2018;131(12):1372–9. https://doi.org/10.1182/blood-2017-11-815746 DOI: https://doi.org/10.1182/blood-2017-11-815746

35. Frairia C, Nicolosi M, Shapiro J, Kim J, Betts BC, Fernandez HF, Locke FL, Mishra A, Nishihori T, Ochoa- Bayona JL, Perez L, Pidala J, Anasetti C. Sole upfront therapy with beclomethasone and budesonide for upper gastrointestinal acute graft-versus-host disease. Biol Blood Marrow Transplant. 2020;26(7):1303–11. https://doi.org/10.1016/j.bbmt.2020.04.023 DOI: https://doi.org/10.1016/j.bbmt.2020.04.023

36. Ibrahim RB, Abidi MH, Cronin SM, Lum LG, Al-Kadhimi Z, Ratanatharathorn V, Uberti JP. Nonabsorbable corticosteroids use in the treatment of gastrointestinal graft-versus-host disease. Biol Blood Marrow Transplant. 2009;15(4):395–405. https://doi.org/10.1016/j.bbmt.2008.12.487 DOI: https://doi.org/10.1016/j.bbmt.2008.12.487

37. Benito AI, Furlong T, Martin PJ, Anasetti C, Appelbaum FR, Doney K, Nash RA, Papayannopoulou T, Storb R, Sullivan KM, Witherspoon R, Deeg HJ. Sirolimus (rapamycin) for the treatment of steroidrefractory acute graft-versus-host disease. Transplantation. 2001;72(12):1924–9. https://doi.org/10.1097/00007890-200112270-00010 DOI: https://doi.org/10.1097/00007890-200112270-00010

38. Cutler C, Antin JH. Sirolimus immunosuppression for graft-versus-host disease prophylaxis and therapy: an update: Curr Opin Hematol. 2010;17(6):500–4. https://doi.org/10.1097/moh.0b013e32833e5b2e DOI: https://doi.org/10.1097/MOH.0b013e32833e5b2e

39. Hoda D, Pidala J, Salgado-Vila N, Kim J, Perkins J, Bookout R, Field T, Perez L, Ayala E, Ochoa-Bayona JL, Raychaudhuri J, Alsina M, Greene J, Janssen W, Fernandez HF, Anasetti C, Kharfan-Dabaja MA. Sirolimus for treatment of steroid-refractory acute graft-versus-host disease. Bone Marrow Transplant. 2010;45(8):1347–51. https://doi.org/10.1038/bmt.2009.343 DOI: https://doi.org/10.1038/bmt.2009.343

40. Inagaki J, Nagatoshi Y, Hatano M, Isomura N, Sakiyama M, Okamura J. Low-dose MTX for the treatment of acute and chronic graft-versus-host disease in children. Bone Marrow Transplant. 2008;41(6):571–7. https://doi.org/10.1038/sj.bmt.1705922 DOI: https://doi.org/10.1038/sj.bmt.1705922

41. Wang Y, Xu LP, Liu KY, Liu DH, Wang J, Chen H, Chen YH, Han W, Huang XJ. Low-dose MTX combined with low-dose methylprednisolone as a first-line therapy for the treatment of acute GVHD: safety and feasibility. Bone Marrow Transplant. 2011;46(6):892–8. DOI: https://doi.org/10.1038/bmt.2010.197

42. Wang Y, Liu QF, Wu DP, Xu ZL, Han TT, Sun YQ, Huang F, Fan ZP, Xu N, Chen F, Zhao Y, Kong Y, Mo XD, Xu LP, Zhang XH, Liu KY, Huang XJ. Mini-dose methotrexate combined with methylprednisolone for the initial treatment of acute GVHD: a multicentre, randomized trial. BMC Med. 2024;22(1):176. https://doi.org/10.1186/s12916-024-03395-y DOI: https://doi.org/10.1186/s12916-024-03395-y

43. Inagaki J, Fukano R, Kodama Y, Nishimura M, Shimokawa M, Okamura J. Safety and efficacy of low dose methotrexate for pediatric patients with steroid-refractory acute graft-versus-host disease after hematopoietic stem cell transplantation. Ann Hematol. 2014;93(4):645–51. https://doi.org/10.1007/s00277-013-1923-x DOI: https://doi.org/10.1007/s00277-013-1923-x

44. Nassar A, Elgohary G, Elhassan T, Nurgat Z, Mohamed SY, Aljurf M. Methotrexate for the treatment of graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. J Transplant. 2014;2014:980301. https://doi.org/10.1155/2014/980301 DOI: https://doi.org/10.1155/2014/980301

45. Murata M, Ikegame K, Morishita Y, Ogawa H, Kaida K, Nakamae H, Ikeda T, Nishida T, Inoue M, Eto T, Kubo K, Sakura T, Mori T, Uchida N, Ashida T, Matsuhashi Y, Miyazaki Y, Ichinohe T, Atsuta Y, Teshima T. Low-dose thymoglobulin as second-line treatment for steroid-resistant acute GvHD: an analysis of the JSHCT. Bone Marrow Transplant. 2017;52(2):252–7. https://doi.org/10.1038/bmt.2016.247 DOI: https://doi.org/10.1038/bmt.2016.247

46. Pidala J, Kim J, Perkins J, Field T, Fernandez H, Perez L, Ayala E, Kharfan-Dabaja M, Anasetti C. Mycophenolate mofetil for the management of steroid-refractory acute graft vs host disease. Bone Marrow Transplant. 2010;45(5):919–24. https://doi.org/10.1038/bmt.2009.252 DOI: https://doi.org/10.1038/bmt.2009.252

47. Inagaki J, Kodama Y, Fukano R, Noguchi M, Okamura J. Mycophenolate mofetil for treatment of steroidrefractory acute graft-versus-host disease after pediatric hematopoietic stem cell transplantation. Pediatr Transplant. 2015;19(6):652–8. https://doi.org/10.1111/petr.12545 DOI: https://doi.org/10.1111/petr.12545

48. Krejci M, Doubek M, Buchler T, Brychtova Y, Vor- licek J, Mayer J. Mycophenolate mofetil for the treatment of acute and chronic steroid-refracto- ry graft-versus-host disease. Ann Hematol. 2005;84(10):681–5. https://doi.org/10.1007/s00277-005-1070-0 DOI: https://doi.org/10.1007/s00277-005-1070-0

49. Baudard M, Vincent A, Moreau P, Kergueris MF, Harousseau JL, Milpied N. Mycophenolate mofetil for the treatment of acute and chronic GVHD is effective and well tolerated but in- duces a high risk of infectious complications: a series of 21 BM or PBSC transplant patients. Bone Marrow Transplant. 2002; 30(5): 287–95.https://doi.org/10.1038/sj.bmt.1703633 DOI: https://doi.org/10.1038/sj.bmt.1703633

50. Ma CKK, García-Cadenas I, Fox ML, Ai S, Nivison-Smith I, Milliken ST, Dodds A, Fay K, Ma DDF, Martino R, Sierra J, Moore J. Poor prognosis in patients with steroid refractory acute graft versus host disease treated with etanercept: a multi-centre analysis. Bone Marrow Transplant. 2018;53(11):1478–82. https://doi.org/10.1038/s41409-018-0215-4 DOI: https://doi.org/10.1038/s41409-018-0215-4

51. Malard F, Loschi M, Huynh A, Cluzeau T, Guenounou S, Legrand F, Magro L, Orvain C, Charbonnier A, Panz-Klapuch M, Desmier D, Mear JB, Cornillon J, Robin C, Daguindau E, Bilger K, Vehreschild MJGT, Chevallier P, Labussière-Wallet H, Mediavilla C, Couturier MA, Bulabois CE, Camus V, Chantepie S, Ceballos P, Gaugler B, Holler E, Doré J, Prestat E, Gasc C, Plantamura E, Mohty M. Pooled allogeneic faecal microbiota MaaT013 for steroid-resistant gastrointestinal acute graft-versus-host disease: a single-arm, multicentre phase 2 trial. EClinicalMedicine. 2023;62:102111. https://doi.org/10.1016/j.eclinm.2023.102111 DOI: https://doi.org/10.1016/j.eclinm.2023.102111

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01/07/2026

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Rodrigues, A. M., Tavares, R. de C. B. da S., Breviglieri, C. N. M., Silva, M. de M., Gouveia, R. V., Fernandes Junior, V. C. de A., & Bouzas, L. F. (2026). Acute graft-versus-host disease. JOURNAL OF BONE MARROW TRANSPLANTATION AND CELLULAR THERAPY, 6(1). https://doi.org/10.46765/2675-374X.2025v6n1e306

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Vol. 6 No. 1 (2025): Journal of Bone Marrow Transplantation and Cellular Therapy

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Pediatric Consensus Updates

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Copyright (c) 2026 Adriana Mello Rodrigues, Rita de Cassia Barbosa da Silva Tavares, Carla Nolasco Monteiro Breviglieri, Marcia de Matos Silva, Roseane Vasconcelos Gouveia, Virgínio Climaco de Araújo Fernandes Junior, Luis Fernando Bouzas

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Acute graft-versus-host disease

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