PROPOSAL FOR STANDARD RECOMMENDATIONS FOR PROPHYLAXIS OF GRAFT-VERSUS-HOST DISEASE IN CHILDREN

Great variations exist in the practices of graft-versus-host disease p rophylaxis for children undergoing allogeneic stem cell transplantatio n. It was the aim of the EBMT Working Party on Paediatric Diseases and the International Study Group of the BFM-Family, subcommittee bone ma rrow transplantation (IBFM-SG) to define standard recommendation for p revention of GVHD. Thus a survey was carried out among the local repre sentatives of the EBMT WP and IBFM-SG members to define standards for GVHD prophylaxis basing on available literature data, discussion with colleagues and their own experience, Presently the majority of regimen for GVHD prophylaxis are centred on CsA and a short course of MTX wit h addition of some other immunosuppression leg ATG or ALG) in patients with high risk for severe GVHD, The proposal defined different catego ry of patients: patients with malignant disease who are either transpl anted from HLA matched sibling donors or HLA mismatched family donors (or volunteer unrelated donors) and patients with non malignant diseas e who might not benefit from graft-versus-leukaemia effect having eith er an HLA matched sibling donor or an HLA mismatched family donor (or volunteer unrelated donor), Homogenous GVHD prophylaxis for defined pa tient groups should provide better information to optimise strategies in reducing treatment related toxicity and incidence of relapse by inc reasing GVL effect.