Novel strategies for steroid-refractory acute graft-versus-host disease.
OBJECTIVE
Graft-versus-host disease is one of the commonest complications of allogeneic bone marrow or peripheral blood stem cell transplantation. This review will cover advances in the pathophysiology of graft-versus-host disease and new agents under investigation for the treatment of this disorder. Patients developing graft-versus-host disease who fail to respond to steroids have a poor prognosis. In this group of people, morbidity and mortality are very high.


RESULTS
Novel agents are currently under investigation for the treatment of such devastating disorders. Pentostatin, denileukin diftitox, mycophenolate mofetil, extracorporeal photopheresis, and several monoclonal antibodies have been used, some of them with encouraging results.


CONCLUSIONS
As supportive care improves and new agents are added to the armamentarium against steroid-refractory acute graft-versus-host disease, the prognosis of this entity may start to change. Patients with this complication after transplantation should be enrolled, whenever possible, in clinical trials to find effective therapies.
Bolaños-Meade
Javier
J
Department of Medicine, University of Maryland Greenebaum Cancer Center and University of Maryland School of Medicine, Baltimore, Maryland, USA.
Vogelsang
Georgia B
GB
D000208:Acute Disease; D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D004167:Diphtheria Toxin / Q000627:therapeutic use; D004351:Drug Resistance; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007376:Interleukin-2 / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015649:Pentostatin / Q000627:therapeutic use; D017893:Photopheresis / Q000379:methods; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D004167:Diphtheria Toxin; D007376:Interleukin-2; D011993:Recombinant Fusion Proteins; D013256:Steroids; C078456:denileukin diftitox; D015649:Pentostatin; D009173:Mycophenolic Acid