Graft-versus-host disease (GVHD) is a major factor contributing to mortality and morbidity after allogeneic haematopoietic stem-cell transplantation (HSCT). In the last 3 years, there has been regulatory approval of new drugs and considerable change in clinical approaches to prophylaxis and management of GVHD. To standardise treatment approaches, the European Society for Blood and Marrow Transplantation (EBMT) has updated its clinical practice recommendations. We formed a panel of one methodologist and 22 experts in the field of GVHD management. The selection was made on the basis of their role in GVHD management in Europe and their contributions to the field, such as publications, presentations at conferences, and other research. We applied the GRADE process to ten PICO (patient, intervention, comparator, and outcome) questions: evidence was searched for by the panel and graded for each crucial outcome. In two consensus meetings, we discussed the evidence and voted on the wording and strengths of recommendations. Key updates to the recommendations include: (1) primary use of ruxolitinib in steroid-refractory acute GVHD and steroid-refractory chronic GVHD as the new standard of care, (2) use of rabbit anti-T-cell (thymocyte) globulin or post-transplantation cyclophosphamide as standard GVHD prophylaxis in peripheral blood stem-cell transplantations from unrelated donors, and (3) the addition of belumosudil to the available treatment options for steroid-refractory chronic GVHD. The EBMT proposes to use these recommendations as the basis for routine management of GVHD during allogenic HSCT. The current recommendations favour European practice and do not necessarily represent global preferences.

移植物抗宿主病（GVHD）是导致异基因造血干细胞移植（HSCT）后死亡和发病的主要因素。在过去 3 年中，新药获得了监管部门的批准， GVHD 预防和管理的临床方法也发生了巨大变化。为了标准化治疗方法，欧洲血液和骨髓移植协会 (EBMT) 更新了其临床实践建议。我们组建了一个由 1 名方法学家和 22 名 GVHD 管理领域专家组成的小组。此次选择是基于他们在欧洲 GVHD 管理中的作用以及他们对该领域的贡献，例如出版物、会议演讲和其他研究。我们将 GRADE 流程应用于十个 PICO（患者、干预、比较和结果）问题：专家组搜索证据并对每个关键结果进行评分。在两次共识会议上，我们讨论了证据并对建议的措辞和优势进行了投票。建议的主要更新包括：(1)在类固醇难治性急性 GVHD和类固醇难治性慢性 GVHD 中主要使用鲁索替尼作为新的护理标准，(2) 使用兔抗 T 细胞（胸腺细胞）球蛋白或后期治疗-移植环磷酰胺作为来自无关供体的外周血干细胞移植的标准 GVHD 预防，以及 (3) 在类固醇难治性慢性 GVHD 的可用治疗方案中添加贝鲁莫舒地尔。 EBMT 建议使用这些建议作为同种异体 HSCT 期间 GVHD 常规管理的基础。目前的建议有利于欧洲实践，并不一定代表全球偏好。