Article

Immunologic Research

, Volume 49, Issue 1, pp 49-55

Prevention of GVHD without losing GVL effect: windows of opportunity

  • Ping ZhangAffiliated withDepartment of Medicine, Duke University Medical Center
  • , Benny J. ChenAffiliated withDepartment of Medicine, Duke University Medical Center Email author 
  • , Nelson J. ChaoAffiliated withDepartment of Medicine and Immunology, Duke University Medical Center

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Abstract

Allogeneic hematopoietic cell transplantation has developed into a most successful form of immunotherapy for hematologic malignancies in the past 50 years. However, its effectiveness and wider applications have been greatly limited by the development of graft-versus-host disease (GVHD), a potentially lethal side effect associated with this procedure. Since the main effectors for both graft-versus-leukemia (GVL) effect and GVHD are T lymphocytes and these two processes share many similar pathways, it has not been easy to separate GVL from GVHD. Because the clinically used pan immunosuppressive therapy for GVHD prevention also results in decreased GVL effect, the success of allogeneic hematopoietic cell transplantation relies on a small and unpredictable therapeutic window at the present time. This review discusses how we may widen this therapeutic window so that we can reliably prevent GVHD without losing GVL effect.

Keywords

Graft-versus-host disease Graft-versus-leukemia T lymphocytes Memory T cells Allogeneic hematopoietic stem cell transplantation