{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T02:55:17Z","timestamp":1792896917940,"version":"4.5.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003787","name":"Natural Science Foundation of Hebei Province","doi-asserted-by":"publisher","award":["H2020206403"],"award-info":[{"award-number":["H2020206403"]}],"id":[{"id":"10.13039\/501100003787","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The optimal timing of ruxolitinib initiation for acute graft-versus-host disease (aGVHD) prophylaxis after myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains undefined, particularly within anti-thymocyte globulin (ATG)-based platforms. This study compared immediate versus delayed short-course ruxolitinib initiation using a concurrent two-strategy design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center, retrospective, concurrent two-strategy cohort study enrolled 39 consecutive patients aged 15\u201365 years with hematologic malignancies who received standard \u201cBeijing Protocol\u201d backbone plus a 14-day short-course ruxolitinib. Patients were non-randomly assigned to immediate (day +1; n = 19) or delayed (at confirmed neutrophil engraftment; median day +13; n = 20) initiation. Haploidentical transplantation and ATG use were perfectly collinear in this cohort, complicating attribution of outcome differences. Co-primary endpoints were 100-day cumulative incidence of grade II\u2013IV aGVHD and 2-year overall survival (OS). A 1:1 propensity score matching (PSM) analysis (12 pairs) served as a sensitivity analysis. Given the limited sample size, multivariable models were constructed as exploratory analyses and should be interpreted with caution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Delayed initiation was associated with lower 100-day grade II\u2013IV aGVHD (10.0% vs. 42.1%, P\u00a0=\u00a00.031), lower cytomegalovirus (CMV) reactivation (35.0% vs. 73.7%, P\u00a0=\u00a00.025), reduced grade \u22653 hematologic toxicity (35.0% vs. 68.4%, P\u00a0=\u00a00.043), and superior 2-year OS rate (90.0% vs. 57.9%, P\u00a0=\u00a00.012). PSM confirmed these findings (aGVHD: 8.3% vs. 41.7%, P\u00a0=\u00a00.039; OS: 91.7% vs. 58.3%, P\u00a0=\u00a00.028). In the exploratory haploidentical subgroup (n = 26), grade II\u2013IV aGVHD was 11.8% vs. 55.6% (P\u00a0=\u00a00.028) and OS was 94.1% vs. 55.6% (P\u00a0=\u00a00.006). In exploratory multivariable models, immediate initiation was associated with higher aGVHD risk [adjusted subdistribution hazard ratio (sHR) 2.31, 95% CI 1.15\u20134.64, P\u00a0=\u00a00.019] and higher NRM (adjusted sHR 4.65, 95% CI 1.47\u201314.72, P\u00a0=\u00a00.009). Relapse risk was not significantly different (adjusted sHR 2.17, 95% CI 0.85\u20135.56, P\u00a0=\u00a00.095). Pre-transplant measurable residual disease (MRD) positivity was associated with inferior OS (adjusted hazard ratio [HR] 7.81, 95% CI 1.12\u201354.32, P\u00a0=\u00a00.038). Median follow-up was 42.1 months. Interpretation of the CMV reactivation difference is limited by the absence of donor and recipient CMV serostatus data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Delaying short-course ruxolitinib until neutrophil engraftment was associated with reduced aGVHD and NRM and improved survival after myeloablative allo-HSCT. No statistically significant difference in relapse risk was observed, although a clinically meaningful difference cannot be excluded. These findings warrant confirmation in a multicenter randomized trial with adequate sample size, stratified by donor type and pre-transplant MRD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1772778","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T04:22:13Z","timestamp":1784002933000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Immediate versus delayed short-course ruxolitinib for acute GVHD prophylaxis after myeloablative allogeneic hematopoietic stem cell transplantation"],"prefix":"10.3389","volume":"17","author":[{"given":"Huan","family":"Hua","sequence":"first","affiliation":[{"name":"Department of Hematology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, China"]},{"name":"Hebei Key Laboratory of Hematology","place":["Shijiazhuang, 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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengrong","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, China"]},{"name":"Hebei Key Laboratory of Hematology","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziwei","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, China"]},{"name":"Hebei Key Laboratory of Hematology","place":["Shijiazhuang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Hematology, The Second Hospital of Hebei Medical University","place":["Shijiazhuang, China"]},{"name":"Hebei Key Laboratory of Hematology","place":["Shijiazhuang, 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