Onkológia 1/2022

GvHD – prophylaxis and treatment

Graft-versus-host disease (GvHD) is major cause of morbidity and non - relapse mortality (NRM) after allogeneic hematopoietic stem cell transplantation (HSCT). As the number of allogeneic HSCT continues to increase each year, effective prophylaxis and therapy of GvHD are needed to improve outcomes for this potentially curative treatment. Because of the small number of results from the prospective, randomized, controlled clinical studies there is considerable variability in the prevention and treatment of GvHD worldwide. The combination of a calcineurin inhibitor plus an antimetabolite remains the standard of GvHD prophylaxis. Systemic corticosteroids are standard first-line therapy, but are only effective in approximately half of all cases with 50% patients going on to develop steroid - refractory disease. The outcomes of GvHD correlate directly with response to initial immunosuppression (IS). Many available second-line (salvage) GvHD therapies are associated with increased IS, infectious complications and potential loss of the „graft versus tumour“ effect. Currently, there is a need for development of new treatment strategies for both acute and chronic GvHD to improve long-term outcomes of HSCT. This article reviews the current and novel approaches in GvHD prevention and treatment.

Keywords: graft versus host disease, prophylaxis, treatment, immunosuppression, steroid – refractory disease