Graft-versus-host disease (GVHD) is a major factor contributing to mortality and morbidity after allogeneic stem-cell transplantation. Because of the small number of results from well designed, large-scale, clinical studies there is considerable variability in the prevention and treatment of GVHD worldwide. In 2014, to standardise treatment approaches the European Society of Blood and Marrow Transplantation published recommendations on the management of GVHD in the setting of HLA-identical sibling or unrelated donor transplantation in adult patients with haematological malignancies. Here we update these recommendations including the results of study published after 2014. Evidence was searched in three steps: first, a widespread scan of published trials, meta-analyses, and systematic reviews; second, expert opinion was added for specific issues following several rounds of debate; and third, a refined search to target debated or rapidly updating issues. On the basis of this evidence and the 2014 recommendations, five members of the EBMT Transplant Complications Working Party created 38 statements on GVHD prophylaxis, drug management, and treatment of acute and chronic GVHD. Subsequently, they created the EBMT GVHD management recommendation expert panel by recruiting 20 experts with expertise in GVHD management. An email-based, two-round Delphi panel approach was used to manage the consensus. Modified National Comprehensive Cancer Network categories for evidence and consensus were applied to the approved statements. We reached 100% consensus for 29 recommendations and 95% consensus for nine recommendations. Key updates to these recommendations include a broader use of rabbit anti-T-cell globulin; lower steroid doses for the management of grade 2 acute GVHD with isolated skin or upper gastrointestinal tract manifestations; fluticasone, azithromycin, and montelukast should be used for bronchiolitis obliterans syndrome; and the addition of newer treatment options for resteroid-refractory acute and chronic GVHD. In addition, we discuss specific aspects of GVHD prophylaxis and management in the setting of haploidentical transplantation and in paediatric patients, but no formal recommendations on those procedures have been provided in this Review. The European Society of Blood and Marrow Transplantation proposes to use these recommendations as a basis for the routine management of GVHD during stem-cell transplantation.

中文翻译：

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干细胞移植治疗血液系统恶性肿瘤后的移植物抗宿主病的预防和管理：欧洲血液和骨髓移植学会的最新共识建议。

移植物抗宿主病（GVHD）是同种异体干细胞移植后导致死亡率和发病率的主要因素。由于精心设计的大规模临床研究的结果很少，因此全球范围内预防和治疗GVHD的差异很大。2014年，为规范治疗方法，欧洲血液和骨髓移植协会发布了有关在成人血液学恶性肿瘤患者中进行HLA同胞或无关供体移植的GVHD管理建议。在这里，我们更新了这些建议，包括2014年后发表的研究结果。证据的搜索过程分为三个步骤：首先，对已发表的试验，荟萃分析和系统评价进行广泛扫描；第二，经过几轮辩论后，针对特定问题增加了专家意见；第三，针对有争议或快速更新的问题进行精细搜索。根据这些证据和2014年的建议，EBMT移植并发症工作组的五名成员就预防GVHD，药物管理以及急性和慢性GVHD的治疗发表了38项声明。随后，他们通过招募了20名具有GVHD管理专业知识的专家，创建了EBMT GVHD管理推荐专家小组。基于电子邮件的两轮Delphi小组方法用于管理共识。修改后的国家综合癌症网络分类用于证据和共识，用于批准的声明。我们对29条建议达成了100％的共识，对9条建议达成了95％的共识。这些建议的主要更新内容包括广泛使用兔抗T细胞球蛋白；降低类固醇剂量，以治疗具有孤立的皮肤或上消化道表现的2级急性GVHD；氟替卡松，阿奇霉素和孟鲁司特应用于闭塞性细支气管炎综合征。以及为顽固类固醇难治性急性和慢性GVHD增加了新的治疗选择。此外，我们讨论了单倍体移植和小儿患者GVHD预防和治疗的具体方面，但本综述未提供有关这些程序的正式建议。欧洲血液和骨髓移植学会提议将这些建议用作干细胞移植期间GVHD常规管理的基础。