title: Recent progress in managing graft-versus-host disease and viral infections following allogeneic stem cell transplantation.
abstract: Despite recent reductions in transplant-related mortality, post-transplant complications such as graft-versus-host disease (GvHD) remain major obstacles to the successful application of allogeneic hematopoietic transplantation. Steroid-refractory GvHD has a poor outcome. Although there are a variety of new approaches to the treatment of refractory GvHD, many have limited evidence of efficacy. Other approaches appear to be unacceptably toxic. It would be preferable to improve GvHD prophylaxis. There is good evidence that rates of GvHD can be reduced without unacceptable reduction of the graft-versus-leukemia effect or compromising overall survival. However, prophylactic measures aimed at reducing T-cell numbers or functions are associated with high rates of reactivation of latent viruses. New technologies that allow rapid generation of virus-specific T-cells show promise to reduce the frequency and severity of such reactivations and have the potential to revolutionize the approach to post-transplant infectious complications.
authors.affiliation: UCL Cancer Institute, Department of Haematology, London, WC1E 6BT, UK.
authors.forename: Rob S
authors.initials: RS
authors.lastname: Sellar
authors.forename: Karl S
authors.initials: KS
authors.lastname: Peggs
mesh_terms: D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000276:immunology; D000077561:Daclizumab; D000068800:Etanercept; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D000069285:Infliximab; D059630:Mesenchymal Stem Cells; D017893:Photopheresis; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D000069283:Rituximab; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors; D014184:Transplantation, Homologous / Q000009:adverse effects*; D014777:Virus Diseases / Q000209:etiology / Q000628:therapy* / Q000821:virology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D000961:Antilymphocyte Serum; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000074323:Alemtuzumab; D000069283:Rituximab; D000069285:Infliximab; D000077561:Daclizumab; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D000068800:Etanercept