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Taiwan consensus on pulmonary chronic graft‐versus‐host disease: A joint statement from the Taiwan Society of Blood and Marrow Transplantation ( TBMT ) and Taiwan Society of Pulmonary and Critical Care Medicine ( TSPCCM )

Year: 2025

Type: article

Abstract: Pulmonary chronic graft-versus-host disease (cGVHD), particularly bronchiolitis obliterans syndrome (BOS), is a severe complication of allogeneic haematopoietic stem cell transplantation (allo-HSCT) with significant morbidity and mortality. This report, developed collaboratively by experts from the Taiwan Society of Blood and Marrow Transplantation (TBMT) and the Taiwan Society of Pulmonary and Critical Care Medicine (TSPCCM), provides consensus statements for the diagnosis, surveillance and management of pulmonary cGVHD. Early detection through pulmonary function tests (PFTs) is critical, with serial monitoring recommended after allo-HSCT. High-resolution computed tomography (HRCT) serves as a valuable diagnostic tool, whereas bronchoalveolar lavage along with multiplex polymerase chain reaction (PCR) helps rule out infectious aetiologies. The first-line treatment approach includes inhaled and systemic corticosteroids, bronchodilators and azithromycin. The fluticasone-azithromycin-montelukast (FAM) regimen has demonstrated notable efficacy in stabilizing lung function. Emerging therapies such as ruxolitinib, belumosudil, abatacept and axatilimab offer promising benefits for refractory cases, whereas lung transplantation is a viable last resort for advanced disease. Comprehensive supportive care, encompassing pulmonary rehabilitation and infection prophylaxis, is an essential component of management. This consensus report highlights the importance of standardized PFT surveillance, early intervention and individualized immunosuppressive strategies. Future research should focus on refining diagnostic biomarkers and optimizing therapeutic approaches to improve patient outcomes.

Source: British Journal of Haematology

DOI: 10.1111/bjh.70074