Advances in graft-versus-host disease biology and therapy

Here, the authors review the most promising strategies for preventing or treating graft-versus-host disease after allogeneic haematopoietic stem cell transplantation. Approaches that target alloreactive T cells are often favoured, but those that exploit regulatory cell populations are now showing increasing success. Allogeneic haematopoietic stem cell transplantation is used to treat a variety of disorders, but its efficacy is limited by the occurrence of graft-versus-host disease (GVHD). The past decade has brought impressive advances in our understanding of the role of stimulatory and suppressive elements of the adaptive and innate immune systems from both the donor and the host in GVHD pathogenesis. New insights from basic immunology, preclinical models and clinical studies have led to novel approaches for prevention and treatment. This Review highlights the recent advances in understanding the pathophysiology of GVHD and its treatment, with a focus on manipulations of the immune system that are amenable to clinical application.