title: Emerging drugs for prevention of graft failure after allogeneic hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the treatment of choice for many patients suffering from hematological malignancies, severe hemoglobinopathies, bone marrow failures or severe primary immunodeficiencies. Graft rejection/failure (GF) is a life-threatening complication following allo-HSCT that is most commonly caused by the reactivity of recipient T cells, natural killer (NK) cells or antibodies against donor grafted hematopoietic cells. The increasing use of allo-HSCT following reduced-intensity conditioning (RIC) and the increasing use of alternative donors (unrelated cord blood and human leukocyte antigen (HLA)-mismatched donor) have resulted in higher frequency of GF.
  
  
  METHODS
  This review describes the pathogenesis and current prevention and treatment of GF as well as agents in development for GF prevention or treatment.
  
  
  CONCLUSIONS
  The risk of GF may be reduced in the future by optimizing the conditioning regimens and post-grafting immunosuppression, increasing the number of hematopoietic stem cells (HSCs) and/or immune cells transplanted, optimizing HSC homing and better detecting patients at high risk of GF by searching for pre-transplant donor-specific anti-HLA antibodies in patients given grafts from HLA-mismatched donors, or by closely monitoring donor T- and/or NK-cell chimerism after allo-HSCT following RIC.
authors.affiliation: University and CHU of Liège, Division of Hematology, Department of Medicine, CHU Sart-Tilman, 4000 Liège, Belgium. F.Baron@ulg.ac.be
authors.forename: Sophie
authors.initials: S
authors.lastname: Servais
authors.forename: Yves
authors.initials: Y
authors.lastname: Beguin
authors.forename: Frédéric
authors.initials: F
authors.lastname: Baron
mesh_terms: D000818:Animals; D006086:Graft vs Host Disease / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D014184:Transplantation, Homologous