Management of Acute and Chronic GVHD: Current Status and Recent Advances

Graft-versus-host disease (GVHD) is an immune complication post-allogeneic stem-cell transplant, which is associated with mortality and morbidity. Conventional GVHD prophylaxis includes a calcineurin inhibitor with methotrexate for matched related, with the addition of ATG for unrelated transplants. Post-transplant cyclophosphamide has expanded its utility for prophylaxis from haploidentical to matched transplants. With respect to the diagnosis of acute GVHD, the staging and grading system reported by the Mount Sinai Acute GVHD International Consortium has superseded previous systems. Various biomarkers (ST2, REG3α, amphiregulin) have emerged which can prognosticate acute GVHD at multiple time-points—prior to its development, at the time of diagnosis of acute GVHD, and 1 week after systemic treatment of acute GVHD. Moreover, the last decade has seen a multitude of new drugs (ruxolitinib, ibrutinib, belumosudil, axatilimab) that have changed the treatment landscape of both acute and chronic GVHD. The field of GVHD has never been as exciting as present. It suffers the problem of plenty—for prophylaxis, prognostication, and treatment. Herein, we review the recent advances in the field of acute and chronic GVHD.