Risk assessment in haematopoietic stem cell transplantation: GvHD prevention and treatment.
Graft-versus-host disease (GvHD) is the major cause of transplant-related mortality and morbidity. As it is closely related to the major therapeutic principle, graft-versus-leukaemia (GvL) effect, risk assessment has to balance both risks depending on the pre-transplant status. This is clearly demonstrated when comparing the two major strategies for prevention of GvHD. While the majority of approaches aiming at T-cell depletion show efficacy in reducing acute and chronic GvHD and transplant-related mortality, T-cell depletion also affects graft-versus-leukaemia effects and thus results in a higher relapse rate. Thus, standard prophylaxis relying on calcineurin inhibitors frequently results in at least equivalent or even superior long-term disease-free survival, and the risk of relapse has to be considered when selecting regimens for prevention of GvHD. In addition to this general dilemma, drug-specific side-effects and risks have to be considered when selecting regimens for GvHD prevention and treatment.
Holler
Ernst
E
Department of Haematology/Oncology, University of Regensburg, Medical Centre, Franz-Josef Strauss Allee 11, 93042 Regensburg, Germany. ernst.holler@klinik.uni-regensburg.de
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D065095:Calcineurin Inhibitors; D002908:Chronic Disease / Q000188:drug therapy; D016572:Cyclosporine / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000517:prevention & control*; D020544:Graft vs Leukemia Effect / Q000187:drug effects; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D008775:Methylprednisolone / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D018570:Risk Assessment; D013601:T-Lymphocytes / Q000502:physiology; D016559:Tacrolimus / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D016559:Tacrolimus; D008775:Methylprednisolone; D008727:Methotrexate