# GVHD prophylaxis after allogeneic stem cell transplant: choosing the regimen

Source: https://onco.cc/protocols/allo-hct-gvhd-prophylaxis/  
OnCo record `allo-hct-gvhd-prophylaxis` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

After a donor transplant, everyone takes medicines to stop the donor's immune cells attacking their body (graft-versus-host disease). The combination depends on the donor, the pre-transplant treatment and whether the cells came from blood or marrow. Newer combinations reduce graft-versus-host disease; in the main trial they did not lengthen life, and each has its own side effects.

## Summary

EBMT 2024 (GRADE, ten PICO questions, 22 experts and a methodologist; abstract read): rabbit anti-T-cell globulin (ATG) or post-transplantation cyclophosphamide (PTCy) is standard prophylaxis in peripheral blood stem cell transplants from unrelated donors; ruxolitinib is the new standard for steroid-refractory acute and chronic GVHD; belumosudil is added for steroid-refractory chronic GVHD. The panel states its recommendations favour European practice.

BMT CTN 1703 (phase III, 431 adults, reduced-intensity conditioning, matched related or matched or 7/8 unrelated donors): PTCy-tacrolimus-mycophenolate mofetil gave more GVHD-free, relapse-free survival at one year than tacrolimus-methotrexate (52.7% against 34.9%; HR 0.64), with no substantial difference in overall or disease-free survival, relapse, transplant-related death or engraftment.

ABHH/SBTMO 2026 (GRADE systematic review, 11 PICO questions, 54 studies): calcineurin inhibitor plus methotrexate reduces acute GVHD (very low quality); calcineurin inhibitor plus mycophenolate can be preferred after myeloablative conditioning for less mucositis and toxicity; adding rATG is recommended; calcineurin inhibitor plus mycophenolate after reduced-intensity conditioning; high-dose PTCy (50 mg/kg days +3 and +4) with a calcineurin inhibitor with or without mycophenolate for haploidentical donors, and with reduced chronic GVHD in matched donors (RCTs) at the cost of more haemorrhagic cystitis (cohorts); PTCy with ATG raises EBV reactivation; abatacept added to calcineurin inhibitor and methotrexate lowers grade III to IV acute GVHD (very low quality).

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: GvHD prophylaxis regimen; post-transplant cyclophosphamide; PTCy; ATG prophylaxis; calcineurin inhibitor and methotrexate; tacrolimus and mycophenolate
- Tags: protocol; cell-therapy; transplant; gvhd

## Connected records

- technologies: [Allogeneic stem cell transplantation](https://onco.cc/technologies/allogeneic-hsct/), [Preventing graft-versus-host disease, and what prevention costs](https://onco.cc/technologies/gvhd-prophylaxis/), [When steroids fail: ruxolitinib for steroid-refractory GvHD](https://onco.cc/technologies/gvhd-ruxolitinib-steroid-refractory/)
- drugs: [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Methotrexate](https://onco.cc/drugs/methotrexate/), [Sirolimus](https://onco.cc/drugs/sirolimus/)
- terms: [Conditioning regimen (myeloablative, reduced-intensity)](https://onco.cc/terms/conditioning-regimen/), [Graft-versus-host disease (GVHD) and graft-versus-leukaemia](https://onco.cc/terms/gvhd/)

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