Management of acute graft-versus-host disease after allogeneic bone marrow transplantation

Graft-versus-host disease (GVHD) is the most significant Life-threatening complication patients encounter after marrow transplantation. Its direct toxicity and secondary immunodeficiency with complicating infection is a major barrier to success of allografts, particularly from donors other than histocompatible siblings. GVHD is induced by a multifactorial cascade of cytotoxic conditioning injuring epithelial targets and altering alloantigen expression, plus activated T cells, cytokines and inflammatory effecters yielding the characteristic maculopapular rash, cholestasis and secretory diarrhea. Additional investigations into the pathogenesis of GVHD have suggested new potential avenues for therapy directed at the etiopathogenesis of the syndrome. Despite the promise of newer pathophysiologic understanding, management of acute GVHD centers on supportive care (nutrition, hydration, infection prophylaxis) and broad potent immunosuppressive therapy, usually involving cyclosporine, prednisone and anti-T-cell antibodies. Both advances in basic science and additional clinical inverstigation are needed to improve the management of acute GVHD.