Acute graft-versus-host disease

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.