CURRENT PERSPECTIVES ON THE MANAGEMENT OF ACUTE GRAFT-VERSUS-HOST DISEASE IN PEDIATRIC TRANSPLANTATION
Abstract
Background: Hematopoietic stem cell transplantation (HSCT) has expanded its scope as a curative therapy for a wide range of severe pediatric diseases. However, its efficacy is frequently challenged by graft-versus-host disease (GVHD), a significant and potentially fatal complication. This is particularly relevant in the pediatric population, where unique immunological and physiological factors contribute to a distinct disease course.
Objective: This narrative review synthesizes the current evidence base on the treatment and management of GVHD in pediatric patients. It aims to provide a critical appraisal of the unique immunological determinants, current prophylactic and treatment interventions, and the long-term morbidities and clinical needs for this specific field.
Methods: A comprehensive systematic search of databases, including PubMed, Embase, and the Cochrane Library, was conducted to identify relevant literature. Articles were selected based on inclusion criteria focusing on GVHD management in patients aged 18 or younger, while excluding non-peer-reviewed articles and case reports. Data on study design, patient populations, treatment regimens, and key outcomes were extracted and synthesized.
Summary: The pathogenesis of acute GVHD (aGVHD) is described by the classic three-phase model, beginning with host tissue damage, followed by donor T-cell activation, and culminating in targeted organ destruction, particularly in the skin, liver, and gastrointestinal tract. Diagnostic methods have evolved from clinical and histological assessments to include advanced biomarker-driven approaches, such as the MAGIC algorithm, which provides more precise prognostic risk stratification. Current prophylaxis strategies primarily involve calcineurin inhibitors in combination with methotrexate or mycophenolate mofetil. Novel agents like ruxolitinib and vedolizumab are emerging as promising therapeutic tools for both prophylaxis and the treatment of steroid-refractory disease. Despite these advancements, significant clinical gaps persist, as many established guidelines for GVHD management are not tailored to the pediatric population. The evident age-related disparity in GVHD risk highlights the critical need for pediatric-specific research.
Conclusion: While substantial progress has been made in understanding and treating GVHD, there is a clear and urgent need for further research focused on pediatric-specific protocols. Continued efforts to validate existing therapies in pediatric cohorts, explore novel agents, and leverage biomarkers are essential to improve outcomes and the quality of life for young patients undergoing HSCT.
References
Akahoshi, Y., Spyrou, N., Weber, D., Aguayo-Hiraldo, P. I., Ayuk, F., Bunworasate, U., Choe, H., Eder, M., Etra, A., Grupp, S. A., Hexner, E. O., Hogan, W. J., Kitko, C. L., Kraus, S., Merli, P., Qayed, M., Reshef, R., Schechter, T., Ullrich, E., . . . Levine, J. E. (2024). The Mount Sinai Acute Gvhd International Consortium (MAGIC) Model: An Integrated Clinical and Biomarker Grading System for Acute Graft-Versus-Host Disease (GVHD). Transplantation and Cellular Therapy, 30(2), S52-S53. https://doi.org/10.1016/j.jtct.2023.12.087
Baird, K., Cooke, K., & Schultz, K. R. (2010). Chronic graft-versus-host disease (GVHD) in children. Pediatric Clinics of North America, 57(1), 297-322. https://doi.org/10.1016/j.pcl.2009.11.003
Bleakley, M., Sehgal, A., Seropian, S., Biernacki, M. A., Krakow, E. F., Dahlberg, A., Persinger, H., Hilzinger, B., Martin, P. J., Carpenter, P. A., Flowers, M. E., Voutsinas, J., Gooley, T. A., Loeb, K., Wood, B. L., Heimfeld, S., Riddell, S. R., & Shlomchik, W. D. (2022). Naive T-Cell Depletion to Prevent Chronic Graft-Versus-Host Disease. Journal of Clinical Oncology, 40(11), 1174-1185. https://doi.org/10.1200/JCO.21.01755
Bolanos-Meade, J., Reshef, R., Fraser, R., Fei, M., Abhyankar, S., Al-Kadhimi, Z., Alousi, A. M., Antin, J. H., Arai, S., Bickett, K., Chen, Y. B., Damon, L. E., Efebera, Y. A., Geller, N. L., Giralt, S. A., Hari, P., Holtan, S. G., Horowitz, M. M., Jacobsohn, D. A., . . . Koreth, J. (2019). Three prophylaxis regimens (tacrolimus, mycophenolate mofetil, and cyclophosphamide; tacrolimus, methotrexate, and bortezomib; or tacrolimus, methotrexate, and maraviroc) versus tacrolimus and methotrexate for prevention of graft-versus-host disease with haemopoietic cell transplantation with reduced-intensity conditioning: a randomised phase 2 trial with a non-randomised contemporaneous control group (BMT CTN 1203). Lancet Haematol, 6(3), e132-e143. https://doi.org/10.1016/S2352-3026(18)30221-7
Chen, Y. B., Mohty, M., Zeiser, R., Teshima, T., Jamy, O., Maertens, J., Purtill, D., Chen, J., Cao, H., Rossiter, G., Jansson, J., & Floisand, Y. (2024). Vedolizumab for the prevention of intestinal acute GVHD after allogeneic hematopoietic stem cell transplantation: a randomized phase 3 trial. Nature Medicine, 30(8), 2277-2287. https://doi.org/10.1038/s41591-024-03016-4
Cheng, C. Y., Lu, M. Y., Chang, H. H., Yang, Y. L., Wu, C. H., Lin, D. T., Lin, K. H., Chou, S. W., & Jou, S. T. (2025). Ruxolitinib for pediatric acute and chronic graft-versus-host disease: a single-center retrospective study of efficacy and safety. Annals of Hematology, 104(1), 753-760. https://doi.org/10.1007/s00277-025-06225-0
Chopra, Y., Acevedo, K., Muise, A., Frost, K., Schechter, T., Krueger, J., Ali, M., Chiang, K. Y., Kim, V. H., Grunebaum, E., & Wall, D. (2024). Gut Immunomodulation with Vedolizumab prior to Allogeneic Hematopoietic Stem Cell Transplantation in Pediatric Patients with Inflammatory Bowel Disease. Transplant Cell Ther, 30(5), 546 e541-546 e547. https://doi.org/10.1016/j.jtct.2024.03.006
Cisek, J., Dąbrowska, A., Majk, A., & Czyżewski, K. (2024). Use of vedolizumab in children with steroid-refractory gastro-intestinal graft-versus-host disease. Acta Haematologica Polonica, 55(5), 273-275. https://doi.org/10.5603/ahp.101814
Das-Gupta, E., Dignan, F., Shaw, B., Raj, K., Malladi, R., Gennery, A., Bonney, D., Taylor, P., & Scarisbrick, J. (2014). Extracorporeal photopheresis for treatment of adults and children with acute GVHD: UK consensus statement and review of published literature. Bone Marrow Transplantation, 49(10), 1251-1258. https://doi.org/10.1038/bmt.2014.106
DeFilipp, Z., Kim, H. T., Knight, L., Kelley, D., Byrne, M. T., Schroeder, M. A., Tamari, R., Wall, S. A., Vasu, S., Abedin, S., El-Jawahri, A. R., McAfee, S. L., Chen, Y.-B., & Hobbs, G. (2022). Prolonged Post-Transplant Ruxolitinib Therapy is Associated with Protection from Severe Gvhd after Allogeneic HCT. Transplantation and Cellular Therapy, 28(3), S305-S306. https://doi.org/10.1016/s2666-6367(22)00553-x
DeFilipp, Z., Kim, H. T., Knight, L. W., O’Connor, S. M., Dhaver, S. E., White, M., Dholaria, B., Schroeder, M. A., Vasu, S., Abedin, S., Chung, J., El-Jawahri, A., Frigault, M. J., McAfee, S., Newcomb, R. A., O’Donnell, P. V., Spitzer, T. R., Chen, Y.-B., & Hobbs, G. S. (2025). Low rates of chronic graft-versus-host disease with ruxolitinib maintenance following allogeneic HCT. Blood, 145(20), 2312-2316. https://doi.org/10.1182/blood.2024028005
Elmariah, H., Otoukesh, S., Kumar, A., Ali, H., Arslan, S., Shouse, G., Pourhassan, H., Nishihori, T., Faramand, R., Mishra, A., Khimani, F., Fernandez, H., Lazaryan, A., Nieder, M., Perez, L., Liu, H., Nakamura, R., Pidala, J., Marcucci, G., . . . Al Malki, M. M. (2024). Sirolimus Is an Acceptable Alternative to Tacrolimus for Graft-versus-Host Disease Prophylaxis after Haploidentical Peripheral Blood Stem Cell Transplantation with Post-Transplantation Cyclophosphamide. Transplant Cell Ther, 30(2), 229 e221-229 e211. https://doi.org/10.1016/j.jtct.2023.11.010
Fałkowska, A. I., Jakubas, A., Surdacka, L., Jagiełło, J., Drabko, K., & Zaucha-Prażmo, A. (2023). Safe use of fecal microbiota transplant in treatment of graft versus host disease in a 5-year-old child. Acta Haematologica Polonica, 54(4), 266-268. https://doi.org/10.5603/ahp.95288
Farag, S. S., Abu Zaid, M., Schwartz, J. E., Thakrar, T. C., Blakley, A. J., Abonour, R., Robertson, M. J., Broxmeyer, H. E., & Zhang, S. (2021). Dipeptidyl Peptidase 4 Inhibition for Prophylaxis of Acute Graft-versus-Host Disease. New England Journal of Medicine, 384(1), 11-19. https://doi.org/10.1056/NEJMoa2027372
Ferrara, J. L., Cooke, K. R., & Teshima, T. (2003). The pathophysiology of acute graft-versus-host disease. International Journal of Hematology, 78(3), 181-187. https://doi.org/10.1007/BF02983793
Ferrara, J. L., Levine, J. E., Reddy, P., & Holler, E. (2009). Graft-versus-host disease. Lancet, 373(9674), 1550-1561. https://doi.org/10.1016/S0140-6736(09)60237-3
Fiuza-Luces, C., Simpson, R. J., Ramirez, M., Lucia, A., & Berger, N. A. (2016). Physical function and quality of life in patients with chronic GvHD: a summary of preclinical and clinical studies and a call for exercise intervention trials in patients. Bone Marrow Transplantation, 51(1), 13-26. https://doi.org/10.1038/bmt.2015.195
Foeken, L. M., Green, A., Hurley, C. K., Marry, E., Wiegand, T., Oudshoorn, M., & Donor Registries Working Group of the World Marrow Donor, A. (2010). Monitoring the international use of unrelated donors for transplantation: the WMDA annual reports. Bone Marrow Transplantation, 45(5), 811-818. https://doi.org/10.1038/bmt.2010.9
Glucksberg, H., Storb, R., Fefer, A., Buckner, C. D., Neiman, P. E., Clift, R. A., Lerner, K. G., & Thomas, E. D. (1974). Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation, 18(4), 295-304. https://doi.org/10.1097/00007890-197410000-00001
Gottardi, F., Leardini, D., Muratore, E., Baccelli, F., Cerasi, S., Venturelli, F., Zanaroli, A., Belotti, T., Prete, A., & Masetti, R. (2023). Treatment of steroid-refractory graft versus host disease in children. Front Transplant, 2, 1251112. https://doi.org/10.3389/frtra.2023.1251112
Guilcher, G. M. (2016). Hematopoietic Stem Cell Transplantation in Children and Adolescents. Pediatrics in Review, 37(4), 135-144; quiz 145. https://doi.org/10.1542/pir.2015-0044
Hill, G. R., Betts, B. C., Tkachev, V., Kean, L. S., & Blazar, B. R. (2021). Current Concepts and Advances in Graft-Versus-Host Disease Immunology. Annual Review of Immunology, 39, 19-49. https://doi.org/10.1146/annurev-immunol-102119-073227
Hong, J., Fraebel, J., Yang, Y., Tkacyk, E., Kitko, C., & Kim, T. K. (2023). Understanding and treatment of cutaneous graft-versus-host-disease. Bone Marrow Transplantation, 58(12), 1298-1313. https://doi.org/10.1038/s41409-023-02109-x
Huang, K., Yang, M., Huang, J., Cao, Y., Zhou, Y., Pang, G., Zhao, J., & Luo, J. (2025). Soluble ST2 as a Predictive Biomarker for Acute Graft-Versus-Host Disease Post -Allogeneic Stem Cell Transplantation. Clinical Transplantation, 39(3), e70108. https://doi.org/10.1111/ctr.70108
Jagasia, M. H., Greinix, H. T., Arora, M., Williams, K. M., Wolff, D., Cowen, E. W., Palmer, J., Weisdorf, D., Treister, N. S., Cheng, G. S., Kerr, H., Stratton, P., Duarte, R. F., McDonald, G. B., Inamoto, Y., Vigorito, A., Arai, S., Datiles, M. B., Jacobsohn, D., . . . Flowers, M. E. (2015). National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report. Biology of Blood and Marrow Transplantation, 21(3), 389-401 e381. https://doi.org/10.1016/j.bbmt.2014.12.001
Jamy, O., Zeiser, R., & Chen, Y. B. (2023). Novel developments in the prophylaxis and treatment of acute GVHD. Blood, 142(12), 1037-1046. https://doi.org/10.1182/blood.2023020073
Khandelwal, P., Emoto, C., Fukuda, T., Vinks, A. A., Neumeier, L., Dandoy, C. E., El-Bietar, J., Chandra, S., Davies, S. M., Bleesing, J. J., Jordan, M. B., Mehta, P. A., Jodele, S., Grimley, M. S., Kumar, A., Myers, K. C., & Marsh, R. A. (2016). A Prospective Study of Alemtuzumab as a Second-Line Agent for Steroid-Refractory Acute Graft-versus-Host Disease in Pediatric and Young Adult Allogeneic Hematopoietic Stem Cell Transplantation. Biology of Blood and Marrow Transplantation, 22(12), 2220-2225. https://doi.org/10.1016/j.bbmt.2016.09.016
Khandelwal, P., Fukuda, T., Teusink-Cross, A., Kashuba, A. D. M., Marsh, R. A., Mehta, P. A., Vinks, A., Nelson, A. S., Myers, K. C., Krupski, M. C., Jordan, M. B., Grimley, M. S., Chandra, S., Bleesing, J. J., & Davies, S. M. (2019). Pediatric Phase II Study of Maraviroc for Acute Graft Versus Host Disease Prophylaxis. Biology of Blood and Marrow Transplantation, 25(3), S251-S252. https://doi.org/10.1016/j.bbmt.2018.12.253
Kolb, M., Bhatia, M., Madina, G. G., & Satwani, P. (2015). Effective use of tocilizumab for the treatment of steroid-refractory gastrointestinal acute graft versus host disease in a child with very high levels of serum interleukin-6. Pediatric Blood & Cancer, 62(2), 362-363. https://doi.org/10.1002/pbc.25231
Koyama, M., & Hill, G. R. (2019). The primacy of gastrointestinal tract antigen-presenting cells in lethal graft-versus-host disease. Blood, 134(24), 2139-2148. https://doi.org/10.1182/blood.2019000823
Kurtzberg, J., Abdel-Azim, H., Carpenter, P., Chaudhury, S., Horn, B., Mahadeo, K., Nemecek, E., Neudorf, S., Prasad, V., Prockop, S., Quigg, T., Satwani, P., Cheng, A., Burke, E., Hayes, J., Skerrett, D., & Group, M.-G. S. (2020). A Phase 3, Single-Arm, Prospective Study of Remestemcel-L, Ex Vivo Culture-Expanded Adult Human Mesenchymal Stromal Cells for the Treatment of Pediatric Patients Who Failed to Respond to Steroid Treatment for Acute Graft-versus-Host Disease. Biology of Blood and Marrow Transplantation, 26(5), 845-854. https://doi.org/10.1016/j.bbmt.2020.01.018
Kuykendall, T. D., & Smoller, B. R. (2003). Lack of specificity in skin biopsy specimens to assess for acute graft-versus-host disease in initial 3 weeks after bone-marrow transplantation. Journal of the American Academy of Dermatology, 49(6), 1081-1085. https://doi.org/10.1016/s0190-9622(03)02098-x
Lankester, A. C., Albert, M. H., Booth, C., Gennery, A. R., Gungor, T., Honig, M., Morris, E. C., Moshous, D., Neven, B., Schulz, A., Slatter, M., Veys, P., Inborn Errors Working Party of the European Society for, B., Marrow, T., the European Society for Immune, D., & European Reference Network on Rare Primary Immunodeficiency Autoinflammatory Autoimmune, d. (2021). EBMT/ESID inborn errors working party guidelines for hematopoietic stem cell transplantation for inborn errors of immunity. Bone Marrow Transplantation, 56(9), 2052-2062. https://doi.org/10.1038/s41409-021-01378-8
Lawitschka, A., Lucchini, G., Strahm, B., Dalle, J. H., Balduzzi, A., Gibson, B., Diaz De Heredia, C., Wachowiak, J., Dalissier, A., Vettenranta, K., Yaniv, I., Bordon, V., Bauer, D., Bader, P., Meisel, R., Peters, C., Corbacioglu, S., & European Society for Blood, M. T. P. D. W. P. (2020). Pediatric acute graft-versus-host disease prophylaxis and treatment: surveyed real-life approach reveals dissimilarities compared to published recommendations. Transplant International, 33(7), 762-772. https://doi.org/10.1111/tri.13601
Locatelli, F., Kang, H. J., Bruno, B., Gandemer, V., Rialland, F., Faraci, M., Takahashi, Y., Koh, K., Bittencourt, H., Cleary, G., Rosko, C., Li, X., St Pierre, A., Prahallad, A., & Diaz-de-Heredia, C. (2024). Ruxolitinib for pediatric patients with treatment-naive and steroid-refractory acute graft-versus-host disease: the REACH4 study. Blood, 144(20), 2095-2106. https://doi.org/10.1182/blood.2023022565
Locatelli, F., Merli, P., Pagliara, D., Li Pira, G., Falco, M., Pende, D., Rondelli, R., Lucarelli, B., Brescia, L. P., Masetti, R., Milano, G. M., Bertaina, V., Algeri, M., Pinto, R. M., Strocchio, L., Meazza, R., Grapulin, L., Handgretinger, R., Moretta, A., . . . Moretta, L. (2017). Outcome of children with acute leukemia given HLA-haploidentical HSCT after αβ T-cell and B-cell depletion. Blood, 130(5), 677-685. https://doi.org/10.1182/blood-2017-04-779769
Malard, F., Loschi, M., Huynh, A., Cluzeau, T., Guenounou, S., Legrand, F., Magro, L., Orvain, C., Charbonnier, A., Panz-Klapuch, M., Desmier, D., Mear, J. B., Cornillon, J., Robin, C., Daguindau, E., Bilger, K., Vehreschild, M., Chevallier, P., Labussiere-Wallet, H., . . . Mohty, M. (2023). Pooled allogeneic faecal microbiota MaaT013 for steroid-resistant gastrointestinal acute graft-versus-host disease: a single-arm, multicentre phase 2 trial. EClinicalMedicine, 62, 102111. https://doi.org/10.1016/j.eclinm.2023.102111
Mathewson, N. D., Jenq, R., Mathew, A. V., Koenigsknecht, M., Hanash, A., Toubai, T., Oravecz-Wilson, K., Wu, S. R., Sun, Y., Rossi, C., Fujiwara, H., Byun, J., Shono, Y., Lindemans, C., Calafiore, M., Schmidt, T. M., Honda, K., Young, V. B., Pennathur, S., . . . Reddy, P. (2016). Gut microbiome-derived metabolites modulate intestinal epithelial cell damage and mitigate graft-versus-host disease. Nature Immunology, 17(5), 505-513. https://doi.org/10.1038/ni.3400
Matsukuma, K. E., Wei, D., Sun, K., Ramsamooj, R., & Chen, M. (2016). Diagnosis and differential diagnosis of hepatic graft versus host disease (GVHD). Journal of Gastrointestinal Oncology, 7(Suppl 1), S21-31. https://doi.org/10.3978/j.issn.2078-6891.2015.036
Naymagon, S., Naymagon, L., Wong, S. Y., Ko, H. M., Renteria, A., Levine, J., Colombel, J. F., & Ferrara, J. (2017). Acute graft-versus-host disease of the gut: considerations for the gastroenterologist. Nature Reviews: Gastroenterology & Hepatology, 14(12), 711-726. https://doi.org/10.1038/nrgastro.2017.126
Olivieri, A., & Mancini, G. (2024). Current Approaches for the Prevention and Treatment of Acute and Chronic GVHD. Cells, 13(18). https://doi.org/10.3390/cells13181524
Peled, J. U., Gomes, A. L. C., Devlin, S. M., Littmann, E. R., Taur, Y., Sung, A. D., Weber, D., Hashimoto, D., Slingerland, A. E., Slingerland, J. B., Maloy, M., Clurman, A. G., Stein-Thoeringer, C. K., Markey, K. A., Docampo, M. D., Burgos da Silva, M., Khan, N., Gessner, A., Messina, J. A., . . . van den Brink, M. R. M. (2020). Microbiota as Predictor of Mortality in Allogeneic Hematopoietic-Cell Transplantation. New England Journal of Medicine, 382(9), 822-834. https://doi.org/10.1056/NEJMoa1900623
Penack, O., Marchetti, M., Aljurf, M., Arat, M., Bonifazi, F., Duarte, R. F., Giebel, S., Greinix, H., Hazenberg, M. D., Kroger, N., Mielke, S., Mohty, M., Nagler, A., Passweg, J., Patriarca, F., Ruutu, T., Schoemans, H., Solano, C., Vrhovac, R., . . . Peric, Z. (2024). Prophylaxis and management of graft-versus-host disease after stem-cell transplantation for haematological malignancies: updated consensus recommendations of the European Society for Blood and Marrow Transplantation. Lancet Haematol, 11(2), e147-e159. https://doi.org/10.1016/S2352-3026(23)00342-3
Penack, O., Marchetti, M., Ruutu, T., Aljurf, M., Bacigalupo, A., Bonifazi, F., Ciceri, F., Cornelissen, J., Malladi, R., Duarte, R. F., Giebel, S., Greinix, H., Holler, E., Lawitschka, A., Mielke, S., Mohty, M., Arat, M., Nagler, A., Passweg, J., . . . Basak, G. W. (2020). Prophylaxis and management of graft versus host disease after stem-cell transplantation for haematological malignancies: updated consensus recommendations of the European Society for Blood and Marrow Transplantation. Lancet Haematol, 7(2), e157-e167. https://doi.org/10.1016/S2352-3026(19)30256-X
Pulsipher, M. A., Langholz, B., Wall, D. A., Schultz, K. R., Bunin, N., Carroll, W. L., Raetz, E., Gardner, S., Gastier-Foster, J. M., Howrie, D., Goyal, R. K., Douglas, J. G., Borowitz, M., Barnes, Y., Teachey, D. T., Taylor, C., & Grupp, S. A. (2014). The addition of sirolimus to tacrolimus/methotrexate GVHD prophylaxis in children with ALL: a phase 3 Children's Oncology Group/Pediatric Blood and Marrow Transplant Consortium trial. Blood, 123(13), 2017-2025. https://doi.org/10.1182/blood-2013-10-534297
Qayed, M., Wang, T., Hemmer, M. T., Spellman, S., Arora, M., Couriel, D., Alousi, A., Pidala, J., Abdel-Azim, H., Aljurf, M., Ayas, M., Bitan, M., Cairo, M., Choi, S. W., Dandoy, C., Delgado, D., Gale, R. P., Hale, G., Frangoul, H., . . . Horan, J. (2018). Influence of Age on Acute and Chronic GVHD in Children Undergoing HLA-Identical Sibling Bone Marrow Transplantation for Acute Leukemia: Implications for Prophylaxis. Biology of Blood and Marrow Transplantation, 24(3), 521-528. https://doi.org/10.1016/j.bbmt.2017.11.004
Qiao, M., Yang, X., Bao, X., Zhou, J., Zhu, H., Zhang, Y., You, T., Qiu, H., Wang, Y., Xue, S., Sun, A., Han, Y., Ma, X., Wu, X., Wu, D., & Chen, S. (2023). Sitagliptin for Prevention of aGVHD in Patients Received Alternative Donor Transplantations: A Prospective, Multicenter, Open-Label, Randomized Controlled Trial. Blood, 142(Supplement 1), 4922-4922. https://doi.org/10.1182/blood-2023-189348
Rai, V., Dietz, N. E., & Agrawal, D. K. (2016). Immunological basis for treatment of graft versus host disease after liver transplant. Expert Review of Clinical Immunology, 12(5), 583-593. https://doi.org/10.1586/1744666X.2016.1145056
Reddi, S., Senyshyn, L., Ebadi, M., Podlesny, D., Minot, S. S., Gooley, T., Kabage, A. J., Hill, G. R., Lee, S. J., Khoruts, A., & Rashidi, A. (2025). Fecal microbiota transplantation to prevent acute graft-versus-host disease: pre-planned interim analysis of donor effect. Nat Commun, 16(1), 1034. https://doi.org/10.1038/s41467-025-56375-y
Rowlings, P. A., Przepiorka, D., Klein, J. P., Gale, R. P., Passweg, J. R., Henslee-Downey, P. J., Cahn, J. Y., Calderwood, S., Gratwohl, A., Socie, G., Abecasis, M. M., Sobocinski, K. A., Zhang, M. J., & Horowitz, M. M. (1997). IBMTR Severity Index for grading acute graft-versus-host disease: retrospective comparison with Glucksberg grade. British Journal of Haematology, 97(4), 855-864. https://doi.org/10.1046/j.1365-2141.1997.1112925.x
Salomao, M., Dorritie, K., Mapara, M. Y., & Sepulveda, A. (2016). Histopathology of Graft-vs-Host Disease of Gastrointestinal Tract and Liver: An Update. American Journal of Clinical Pathology, 145(5), 591-603. https://doi.org/10.1093/ajcp/aqw050
Schoemans, H. M., Lee, S. J., Ferrara, J. L., Wolff, D., Levine, J. E., Schultz, K. R., Shaw, B. E., Flowers, M. E., Ruutu, T., Greinix, H., Holler, E., Basak, G., Duarte, R. F., Pavletic, S. Z., Party, E. T. C. W., & the, E.-N. I. H. C. G. T. F. (2018). EBMT-NIH-CIBMTR Task Force position statement on standardized terminology & guidance for graft-versus-host disease assessment. Bone Marrow Transplantation, 53(11), 1401-1415. https://doi.org/10.1038/s41409-018-0204-7
Schwab, L., Goroncy, L., Palaniyandi, S., Gautam, S., Triantafyllopoulou, A., Mocsai, A., Reichardt, W., Karlsson, F. J., Radhakrishnan, S. V., Hanke, K., Schmitt-Graeff, A., Freudenberg, M., von Loewenich, F. D., Wolf, P., Leonhardt, F., Baxan, N., Pfeifer, D., Schmah, O., Schonle, A., . . . Zeiser, R. (2014). Neutrophil granulocytes recruited upon translocation of intestinal bacteria enhance graft-versus-host disease via tissue damage. Nature Medicine, 20(6), 648-654. https://doi.org/10.1038/nm.3517
Sharma, N., & Efebera, Y. (2021). Acute Graft-Versus-Host Disease, Prophylaxis and Therapy. OBM Transplantation, 5(1). https://doi.org/10.21926/obm.transplant.2101139
Shaw, P. J., Kan, F., Woo Ahn, K., Spellman, S. R., Aljurf, M., Ayas, M., Burke, M., Cairo, M. S., Chen, A. R., Davies, S. M., Frangoul, H., Gajewski, J., Gale, R. P., Godder, K., Hale, G. A., Heemskerk, M. B., Horan, J., Kamani, N., Kasow, K. A., . . . Pulsipher, M. A. (2010). Outcomes of pediatric bone marrow transplantation for leukemia and myelodysplasia using matched sibling, mismatched related, or matched unrelated donors. Blood, 116(19), 4007-4015. https://doi.org/10.1182/blood-2010-01-261958
Sleight, B. S., Chan, K. W., Braun, T. M., Serrano, A., & Gilman, A. L. (2007). Infliximab for GVHD therapy in children. Bone Marrow Transplantation, 40(5), 473-480. https://doi.org/10.1038/sj.bmt.1705761
Sobkowiak-Sobierajska, A., Lindemans, C., Sykora, T., Wachowiak, J., Dalle, J. H., Bonig, H., Gennery, A., & Lawitschka, A. (2022). Management of Chronic Graft-vs.-Host Disease in Children and Adolescents With ALL: Present Status and Model for a Personalised Management Plan. Front Pediatr, 10, 808103. https://doi.org/10.3389/fped.2022.808103
Socie, G., & Michonneau, D. (2022). Milestones in acute GVHD pathophysiology. Frontiers in Immunology, 13, 1079708. https://doi.org/10.3389/fimmu.2022.1079708
Socie, G., & Ritz, J. (2014). Current issues in chronic graft-versus-host disease. Blood, 124(3), 374-384. https://doi.org/10.1182/blood-2014-01-514752
Solan, L., Kwon, M., Carbonell, D., Dorado, N., Balsalobre, P., Serrano, D., Chicano-Lavilla, M., Anguita, J., Gayoso, J., Diez-Martin, J. L., Martinez-Laperche, C., & Buno, I. (2019). ST2 and REG3alpha as Predictive Biomarkers After Haploidentical Stem Cell Transplantation Using Post-transplantation High-Dose Cyclophosphamide. Frontiers in Immunology, 10, 2338. https://doi.org/10.3389/fimmu.2019.02338
Tavaf, M. J., Verkiani, M. E., Hanzaii, F. P., & Zomorrod, M. S. (2023). Effects of immune system cells in GvHD and corresponding therapeutic strategies. Blood Res, 58(1), 2-12. https://doi.org/10.5045/br.2023.2022192
Triulzi, D. J., & Nalesnik, M. A. (2001). Microchimerism, GVHD, and tolerance in solid organ transplantation. Transfusion, 41(3), 419-426. https://doi.org/10.1046/j.1537-2995.2001.41030419.x
Watkins, B., & Qayed, M. (2023). Novel approaches to acute graft-versus-host disease prevention. Hematology: The Education Program of the American Society of Hematology, 2023(1), 155-163. https://doi.org/10.1182/hematology.2023000426
Watkins, B., Qayed, M., McCracken, C., Bratrude, B., Betz, K., Suessmuth, Y., Yu, A., Sinclair, S., Furlan, S., Bosinger, S., Tkachev, V., Rhodes, J., Tumlin, A. G., Narayan, A., Cribbin, K., Gillespie, S., Gooley, T. A., Pasquini, M. C., Hebert, K., . . . Kean, L. S. (2021). Phase II Trial of Costimulation Blockade With Abatacept for Prevention of Acute GVHD. Journal of Clinical Oncology, 39(17), 1865-1877. https://doi.org/10.1200/JCO.20.01086
West, C. H., Dusome, D. L., Winsor, J., & Rallison, L. B. (2020). Falling Down the Rabbit Hole: Child and Family Experiences of Pediatric Hematopoietic Stem Cell Transplant. Qualitative Health Research, 30(7), 1125-1138. https://doi.org/10.1177/1049732320912410
Yesilipek, M. A. (2014). Hematopoetic stem cell transplantation in children. Turk Pediatri Ars, 49(2), 91-98. https://doi.org/10.5152/tpa.2014.2010
Zeiser, R., & Blazar, B. R. (2017). Acute Graft-versus-Host Disease - Biologic Process, Prevention, and Therapy. New England Journal of Medicine, 377(22), 2167-2179. https://doi.org/10.1056/NEJMra1609337
Zeiser, R., Ringden, O., Sadeghi, B., Gonen-Yaacovi, G., & Segurado, O. G. (2023). Novel therapies for graft versus host disease with a focus on cell therapies. Frontiers in Immunology, 14, 1241068. https://doi.org/10.3389/fimmu.2023.1241068
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