Trends in GVHD epidemiology, prophylaxisw and management: The gruppo italiano per il trapianto di Midollo osseo, cellule staminali emopoietiche e terapia cellulare (GITMO) GVHD24 Study

To the Editor, Despite significant advances in transplant techniques, graft-versus-host disease (GVHD) remains one of the most frequent and challenging complications following allogeneic hematopoietic stem cell transplantation (allo-HSCT) in both adult and pediatric recipients [1]. The increased use of mismatched donors, and reduced intensity conditioning regimens (RIC) have expanded the pool of transplant candidates but have also increased the complexity of GVHD prevention and treatment. Posttransplant cyclophosphamide (PTCy) has become an alternative to in vivo T-cell depletion with anti-thymocyte globulin (ATG) and is now widely used. At the same time, new immunomodulatory agents, such as ruxolitinib, ibrutinib, belumosudil, and axatilimab, have reshaped the therapeutic landscape of steroid-refractory/dependent (SR/D) GVHD, although only ruxolitinib currently has both FDA and EMA approval [2-4]. These advances prompted the European Society for Blood and Marrow Transplantation (EBMT) to issue updated recommendations in 2024 [5]. Yet, how these changes have impacted real-world epidemiology and clinical practice remains incompletely understood.