Managing GVHD: Incidence and Prophylaxis Strategies After AlloHSCT

Summary for Physicians:

GVHD remains a significant complication following alloHSCT, with both acute and chronic forms impacting patient outcomes.

• Incidence of GVHD: Acute GVHD occurs in approximately 30% to 50% of patients, while chronic GVHD develops in 30% to 40%, depending on donor type, conditioning regimen, and GVHD prophylaxis used.
• Standard prophylaxis practices typically include a calcineurin inhibitor (such as tacrolimus or cyclosporine) combined with either methotrexate or mycophenolate mofetil. Many centers are also incorporating posttransplant cyclophosphamide (PTCy), particularly in haploidentical or mismatched donor settings and increasingly in matched donor transplants.
• Practice variation: While core components of GVHD prophylaxis are consistent across institutions, differences may exist based on donor type, institutional protocols, and evolving evidence. Use of PTCy, incorporation of novel agents (eg, abatacept), and individualized risk-based approaches reflect ongoing adaptation in clinical practice.

Nelli Bejanyan reports consulting or advisory role for CareDx, Medexus Pharmaceuticals, Orca Biosystems, AlloVir, TScan Therapeutics, and Pfizer; and research funding from CRISPR Therapeutics. Everett Meyer reports sponsored research from Orca Biosciences, Kyverna; and a scientific advisor role and equity holder for GigaMune, Indee, TRACT, Jura Biosciences.Caspian Oliai reports no relevant disclosures (investigator on the Orca T trial funded by Orca Biosciences). Arpita P. Gandhi reports roles with OncLive, MJH Life Sciences, OrcaBio (research), CareDx (Advisory Board). Amandeep Salhotra reports received funding from Rigel, Bristol Myers Squibb and Orca Biosciences; and speakers bureau for Incyte and Sanofi.