Current Practices on Therapy of Acute Graft Versus Host Disease (aGVHD) in Latin America (LA): Interim Results of a WBMT Survey

BACKGROUND Therapy for acute GVHD are evolutionary scenarios, with new drugs being developed. Therefore, it is important to know how fast these changes are incorporated into clinical practice particularly in low- or middle-income countries. OBJECTIVES To investigate practices in management of GVHD in different world regions, the Worldwide Network for Blood and Marrow Transplantation (WBMT) designed a web-based survey, divided in two parts: part I – prophylaxis, and part II - treatment of GVHD. Here we report the results for treatment of GVHD (part 2) in LA. METHODS The survey was sent by email to the LA centers as a Google form, from June to September 2023, through the Latin American Bone Marrow Transplantation Group (LABMT) and the Brazilian Society for Blood and Marrow Transplantation (SBTMO). RESULTS Of 271 LA Centers sent this survey, 52 (19%) completed part 2. Brazil had most centers represented in this survey (62%). Among 137 Brazilian centers authorized for allo transplants, 32 centers (23%) completed part 2. However, centers which have performed most of the HSCT in LA in 2022 are represented in this survey. Brazilian centers, in this part of the survey, represent 62% of the transplants performed in 2022. Table 1 displays responding centers by country are summarized in Table 1. The initial dose of prednisone or equivalent reported for the treatment of aGVHD grade 2a was mostly 1 mg/kg/day (65%), and for grades 2b and higher was mostly 2 mg/kg/day (77%). Most of the centers (75%) did not combine steroids with other agents as first line treatment for aGVHD. If aGVHD develops after immunosuppressive cessation, most reintroduce the calcineurin inhibitor (63%) in addition to steroids. If the aGVHD developed while receiving immunosuppressive agent(s), the reported preferred option would be to continue all agents and add steroids (71%). Response to treatment was reported to be first evaluated after 3 days (36%). A standard-operating procedure (SOP) for the management of steroid-refractory aGVHD was reported to be available in 61.5% centers but only 15% had the possibility to refer these patients to a clinical trial. The most cited second-line treatment for steroid-refractory aGVHD was ruxolitinib (67%) followed by mycophenolate mofetil (28%), basiliximab (19%), high-dose steroids (17%) and others. Conclusions Current practices in management of aGVHD in LA appears similar to the world. Ruxolitinib is the current preferred second line therapy for steroid refractory aGVHD in LA. Difficulties on access to drugs and lack of availabillity of clinical trials are still barriers to overcome in Latin America.