Graft-versus-host disease prevention (GVHD prevention)

Graft-versus-host disease (GVHD) prevention is a clinical objective and therapeutic strategy rather than a single molecular target, focused on inhibiting donor T-cell mediated attacks on recipient tissues after allogeneic hematopoietic stem cell transplantation (StatPearls, 2023). The biological process of GVHD involves a three-step phase: the conditioning phase (tissue damage), the afferent phase (antigen presentation and T-cell activation), and the efferent phase (cellular and inflammatory effector attack) (Blood, 2020). Prevention strategies aim to disrupt these phases, primarily by targeting T-cell activation and proliferation through various pharmacological agents. Standard prophylaxis often involves calcineurin inhibitors like tacrolimus, which block interleukin-2 production, combined with antimetabolites like methotrexate to inhibit DNA synthesis in rapidly dividing immune cells (NIH, 2024). Newer methods include the use of post-transplant cyclophosphamide to selectively deplete alloreactive T-cells or abatacept to block T-cell costimulation (Journal of Clinical Oncology, 2021). The ultimate goal of GVHD prevention is to minimize systemic morbidity while maintaining the beneficial graft-versus-leukemia effect necessary to prevent cancer relapse. Effective prophylaxis is critical because once established, acute GVHD can be difficult to treat and carries a high risk of mortality. Monitoring for biomarkers like ST2 and REG3α is increasingly used to assess the risk and efficacy of preventive measures (NEJM, 2022).

Other names

GVHD prophylaxisPrevention of graft-versus-host diseaseAllogeneic transplant prophylaxis

GVHD prevention is achieved through systemic immunosuppression, primarily by inhibiting T-cell activation (calcineurin inhibitors), blocking T-cell proliferation (antimetabolites), or depleting alloreactive T-cells (post-transplant cyclophosphamide).