Sirolimus immunosuppression for graft-versus-host disease prophylaxis and therapy: an update.
OBJECTIVE
Sirolimus is being used increasingly as an immunosuppressant in allogeneic hematopoietic stem cell transplantation. This article reviews recent results in sirolimus-based graft-versus-host disease (GVHD) prophylaxis, as well as outcomes using sirolimus for established acute and chronic GVHD.


RESULTS
In uncontrolled experiments, sirolimus provides good control of steroid-resistant acute or chronic GVHD. Similarly, the addition of sirolimus to GVHD prophylaxis regimens appears to reduce the rate of acute GVHD in the myeloablative and reduced-intensity settings, when used in matched, related, and unrelated donor transplantation. The use of sirolimus in haploidentical transplantation is now being explored as well.


CONCLUSIONS
Sirolimus should be considered for use in steroid-resistant acute and chronic GVHD. Sirolimus appears promising as primary prophylaxis for GVHD prevention. Randomized trials are currently being performed to determine whether sirolimus-based immunosuppression is superior to traditional GVHD prophylaxis.
Cutler
Corey
C
Harvard Medical School, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA. corey_cutler@dfci.harvard.edu
Antin
Joseph H
JH
D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D020123:Sirolimus / Q000627:therapeutic use*; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents; D020123:Sirolimus