Prevention and treatment of graft-versus-host disease.

Graft-versus-host disease remains a formidable barrier in allogeneic bone marrow transplantation. Studies have shown that effective prophylaxis results in improved overall survival for patients following allogeneic bone marrow transplantation. Various methods to prevent GVHD have been devised over the years including drug therapy, monoclonal antibodies, and T-cell depletion. Many of these prophylaxis regimens have been successful in improving the outcome in patients, with some regimens resulting in only a 9% incidence of acute GVHD in selected patients. Yet, GVHD remains an important problem for those patients in whom prophylaxis fails. Therapy for GVHD has relied on drugs and monoclonal antibodies, and the results of therapy for severe GVHD have been unsatisfactory. As immunologic understanding of the afferent and efferent phases of GVHD continues to be elucidated, more targeted therapy will be introduced and hopefully will result in better outcomes.