[Novel progress on treatment of acute graft-versus-host disease]

Abstract

Acute graft-versus-host disease (aGVHD) is a common complication after allogeneic hematopoietic stem-cell transplantation. Despite improvements in understanding of transplant immunology, aGVHD remains to be a major cause of mortality for patients after allogeneic hematopoietic stem-cell transplantation. While systemic corticosteroid is standard primary therapy for aGVHD, there is no established standard treatment for patients in the steroid-refractory setting. Over the past decade, monoclonal antibodies, biologic engineering products, and chemotherapeutics with immunomodulatory effects are being used as novel therapies in this disease. Many of these agents, such as mycophenolate mofetil, anti-tumor necrosis factor antibodies, and anti-interleukin-2Ralpha-chain antibodies, have demonstrated promising activity in steroid-refractory aGVHD. But long-term survival remains poor due to a high incidence of infections. The key to improving aGVHD outcomes may, in fact, rest upon successful initial therapy, and timely taper corticosteroids to promote immune reconstitution. Clinical trials combining these newer agents with systemic corticosteroids as initial treatment are under way. In this article some new treatments for acute aGVHD are recommend and summarized.