title: Defining the role of sirolimus in the management of graft-versus-host disease: from prophylaxis to treatment.
abstract: Graft-versus-host disease (GVHD) remains a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Measures developed that have significantly reduced GVHD were also frequently associated with an increased risk of relapse. GVHD and graft-versus-tumor (GVT) effects are tightly linked, and balance between both reactions is difficult to achieve. To have an impact on the outcome and quality of life after HSCT, improvements in current strategies to prevent and treat GVHD while preserving the GVT effect are clearly needed. Sirolimus (rapamycin) is a lipophilic macrocytic lactone with immunosuppressive, antitumor, and antiviral properties. Because of its multiple modes of activities, it is being increasingly used in the management of GVHD. This review aims to summarize its mechanisms of action and potential advantages over other immunosuppressors and to analyze the most relevant studies investigating its role in both prevention and treatment of GVHD.
authors: Division of Haematology-Oncology, Stem Cell Transplant Program Hôpital Maisonneuve-Rosemont, Université de Montréal, Québec, Canada.
authors: Ahmed
authors: A
authors: Abouelnasr
authors: Jean
authors: J
authors: Roy
authors: Sandra
authors: S
authors: Cohen
authors: Thomas
authors: T
authors: Kiss
authors: Silvy
authors: S
authors: Lachance
mesh_terms: D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D020350:Graft vs Tumor Effect / Q000187:drug effects; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D012008:Recurrence; D020123:Sirolimus / Q000627:therapeutic use*; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus