Bone marrow transplantation: New approaches to immunosuppression and management of acute graft-versus-host disease

Jeffery J. Auletta, Kenneth R. Cooke

Research output: Contribution to journalReview article

Abstract

Purpose of review Acute graft-versus-host disease (GVHD) significantly limits the application and the success of allogeneic hematopoietic stem cell transplantation (HSCT). Novel therapies that target the aberrant immune response underlying GVHD are reviewed with particular emphasis on immunomodulatory agents currently incorporated into clinical trials. In addition, regenerative stromal cellular therapy (RSCT) is discussed as an emerging form of novel GVHD therapy. Recent findings Knowledge for transplant immunology, particularly as it relates to underlying pathophysiology of GVHD, has dramatically increased over the last decade. As a result, new immunomodulatory therapies have been used to treat steroid-refractory GVHD. However, their success has been limited by their lack of clinical experience during HSCT as well as by their associated toxicity profiles. RSCT uniquely offers the potential to enhance donor-derived hematopoiesis and immunity and to ameliorate adverse sequelae associated with GVHD. Summary An exciting era incorporating the use of cellular therapeutics during HSCT has arrived. As the experience and understanding for cellular therapies, in general, and RSCT, in particular, increases, so too will their success in benefiting the HSCT recipient beyond limitations of current pharmaceutical agents.

Original languageEnglish (US)
Pages (from-to)30-38
Number of pages9
JournalCurrent opinion in pediatrics
Volume21
Issue number1
DOIs
StatePublished - Feb 1 2009
Externally publishedYes

Keywords

  • Allogeneic hematopoietic stem cell transplantation
  • Graft-versus-host disease
  • Mesenchymal stem cell
  • Multipotent adult progenitor cell
  • Regenerative stromal cellular therapy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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