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Review
. 2008 Oct;1(1):111.
doi: 10.1586/17474086.1.1.111.

Current and future approaches for control of graft-versus-host disease

John Koreth  1 , Joseph H Antin
Affiliations
Review

Current and future approaches for control of graft-versus-host disease

John Koreth et al. Expert Rev Hematol. 2008 Oct.

Abstract

Graft-versus-host disease (GVHD), both acute and chronic, remains one of the major barriers to improving outcomes after allogeneic stem cell transplantation. The pathophysiology of GVHD is complex and incompletely understood. GVHD is believed to arise from the interaction of: tissue damage and proinflammatory cytokines causing activation of antigen-presenting cells (APCs, donor T-cell activation by APCs and cytokines and host tissue injury by effector T lymphocytes and proinflammatory cytokines. There is also a role for additional lymphocyte subtypes (naive and memory T cells, regulatory T cells, natural killer T cells and B cells) in GVHD pathogenesis. Strategies to improve donor-recipient HLA match, and to minimize conditioning toxicity, cytokine release and APC and effector T-lymphocyte activation, will likely improve prophylaxis of acute (and possibly chronic) GVHD. Therapy of established acute and chronic GVHD is still heavily dependent on corticosteroids, despite their limited efficacy and considerable toxicity. Novel agents (and/or combinations of agents) comprising pharmacologic, biologic and cellular therapies targeting specific steps or subsets involved in immune activation will likely comprise future advances in GVHD control. This article reviews the current state of knowledge regarding the prevention and treatment of acute and chronic GVHD. Novel approaches currently undergoing evaluation are also highlighted.

Keywords: allogeneic stem cell transplantation; graft-versus-host disease.

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Conflict of interest statement

Financial & competing interests disclosure: The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Figures

Figure 1
Figure 1. Etiopathogenesis of acute graft-versus-host disease
Modified with permission from [245].
See this image and copyright information in PMC

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References

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    2. • The NIH consensus conference on chronic graft-versus-host disease (GVHD) took a critical step in organizing, codifying and refining how we approach chronic GVHD. The concepts presented should faciliate the development of clinical trials in this important area.

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