Novel Cellular Therapeutic Approaches for the Prevention and Management of Graft-Versus-Host Disease

Purpose of Review: Pharmacologic immunosuppression is the mainstay of treatment for GVHD, but there is a crucial need for new therapeutic approaches. Our review focuses on the preclinical and clinical evidence supporting immune regulatory cell infusions, allograft engineering, and suicide-gene-transduced donor T cells to mitigate GVHD. We also review potential challenges to the adoption and use of these therapies. Recent Findings: Mesenchymal stromal cells and regulatory T cells appear effective in preventing and treating GVHD in preliminary studies, although methods of isolating and expanding these cells differ and warrant further investigation. Elimination of naïve or host-reactive donor T cells from allografts can prevent GVHD but may increase infection risk. Donor T cells engineered with human caspase 9 are rapidly eliminated after inducible gene activation, preventing GVHD. Summary: Cellular therapeutics are a promising approach to mitigate GVHD. Clinical trials are underway domestically and internationally to establish the safety and efficacy of these approaches.

Duke Scholars

Author Nelson Jen An Chao Medicine, Hematologic Malignancies and Cellular Therapy