Have we improved in preventing and treating acute graft-versus-host disease?

Abstract

Purpose of review Acute graft vs. host disease (GVHD) is a considerable source of morbidity and mortality following allogeneic hematopoietic cell transplantation (HCT). Accordingly, progress in the prevention and primary therapy of this complication is needed to improve patient outcomes. Recent findings Guided by insights into acute GVHD pathogenesis, investigators have explored novel cellular and pharmacologic approaches to acute GVHD prevention that demonstrates promise. While pan-T cell depletion has reduced GVHD, novel strategies that selectively deplete alloreactive T cells or modulate the balance of effector T cells and regulatory T cells offer promise to selectively abrogate acute GVHD while retaining protection from primary disease relapse and infectious complications. Summary Divergent approaches in the primary therapy of acute GVHD have explored both combination approaches with standard dose glucocorticoids and additional immunosuppressive agents and conversely steroid-sparing approaches including topical agents such as beclomethasone or sirolimus as a steroid-free approach to acute GVHD therapy. Mature results of high quality clinical trials are needed to determine the optimal therapy that results in effective control of the syndrome and limited toxicity. These complementary outcomes represent the therapeutic goal for future investigation in acute GVHD therapy.

Circulating endothelial cell count: a reliable marker of endothelial damage in patients undergoing hematopoietic stem cell transplantation

“…[1][2][3] To date, the overall incidence of GvHD still remains between 30 and 60% and is approximately associated with a 50% mortality rate, especially in its severe form. [1][2][3] Its current pathogenesis model represents a multiphase process in which the result of the conditioning regimen, the release of cytokines and the antigenic differences between recipient and donor lead donor lymphocytes to attack epithelial cells and mucous membranes in target organs. 3 The release of cytokines and the immune attack result in ongoing tissue damage with further cytokine production and a continuous inflammatory positive feedback loop.…”

Clinical grade expansion of MSCs

“…As the best example, grade III-IV steroid resistant Graft Versus Host Disease (GvHD) in Hematopoietic Stem Cells transplanted patients represents a deadly and extremely painful condition which, at the moment, has not found a validated second or third line therapeutic treatment [19][20][21][22].…”

Acute and chronic Graft-versus-host disease after hematopoietic stem cell transplantation

“…Patients who develop the moderate or severe forms of the disease (overall stages II-IV) have a significantly higher mortality rate than those with the mild form. The moderate and severe forms occur in approximately 40% of all allogeneic HSCTs and without effective prophylaxis, it becomes a severe complication 11,12 .…”