2025 Volume 14 Issue 1 Pages 21-29
Calcineurin inhibitor＋methotrexate has been used as a conventional GVHD prophylaxis for allogeneic haematopoietic stem-cell transplantation (HSCT); however, more intensive GVHD prophylaxis is needed for HSCT with high-risk of GVHD. Antithymocyte globulin (ATG) has been shown the inhibitory effect of GVHD by a series of phase Ⅲ randomized control trials. On the other hand, post-transplant cyclophosphamide (PTCy) has been shown the remarkable GVHD prophylactic effect for HLA haplo-identical transplantation, and now is rapidly expanding for other types of HSCT. Comparative studies of ATG and PTCy is increasing based on retrospective analysis, and interestingly, in which results tend to differ between HLA-matched and HLA-mismatched HSCT. Larger prospective studies are needed to establish the position of both GVHD prophylaxis.
Recently, novel GVHD prophylaxis based on the new mechanism and concept is developing. Abatacept and vedolizumab have been shown the GVHD prophylactic effect in randomized controlled trials, and both are expected to be introduced into clinical practice in Japan.
