Blood and Marrow Transplantation Reviews Vol. 10 No. 2

New T Cell-Activation Inhibitors for Prevention of Acute Graft-Versus-Host Disease

INTRODUCTION

by John R. Wingard, MD
Editor-in-Chief

Graft-versus-host disease (GVHD) is the major cause of morbidity and mortality following allogeneic blood and marrow transplantation. Which immunoprophylaxis regimen is optimal is the subject of numerous studies in the field of transplantation. If one provides insufficient immunosuppression, severe GVHD becomes life threatening. If one gives too much immunosuppression, the transplant recipient is at risk for opportunistic infection, abrogation of the graft-versus-tumor effect, and emergence of EBV lymphoproliferative disorders. Striking the balance between too much and too little immunoprophylaxis to facilitate the development of transplant tolerance and preservation of the graft-versus-tumor effect are the goals of a successful strategy for control of GVHD. During the Tandem BMT Meetings in March 2000, a satellite symposium was held to discuss new developments in strategies to control GVHD. The symposium, sponsored by Fujisawa Healthcare through an unrestricted educational grant, is the information source for this issue of BMTR. In the first presentation, Dr. Nash, from the Fred Hutchinson Cancer Research Center, discusses pre-clinical data of strategies to block the CD28-B7 and CD40-CD40 ligand co-stimulatory pathways and clinical data evaluating new immunosuppressive agents, including rapamycin, mycophenolate, and tacrolimus. Dr. Donna Przepiorka, from Baylor College of Medicine, then discusses clinical trials evaluating cyclosporine and tacrolimus as prophylaxis against GVHD in sibling-matched allogeneic transplantation. Finally, I discuss pharmacokinetics and therapeutic drug monitoring and the practical implications for transplant clinicians. This symposium provides an overview of the current status of GVHD prophylaxis and offers glimpses into new therapeutic strategies that are on the horizon.

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BMTR 10/2

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