Risk assessment in haematopoietic stem cell transplantation: GvHD prevention and treatment

Best Pract Res Clin Haematol. 2007 Jun;20(2):281-94. doi: 10.1016/j.beha.2006.10.001.


Graft-versus-host disease (GvHD) is the major cause of transplant-related mortality and morbidity. As it is closely related to the major therapeutic principle, graft-versus-leukaemia (GvL) effect, risk assessment has to balance both risks depending on the pre-transplant status. This is clearly demonstrated when comparing the two major strategies for prevention of GvHD. While the majority of approaches aiming at T-cell depletion show efficacy in reducing acute and chronic GvHD and transplant-related mortality, T-cell depletion also affects graft-versus-leukaemia effects and thus results in a higher relapse rate. Thus, standard prophylaxis relying on calcineurin inhibitors frequently results in at least equivalent or even superior long-term disease-free survival, and the risk of relapse has to be considered when selecting regimens for prevention of GvHD. In addition to this general dilemma, drug-specific side-effects and risks have to be considered when selecting regimens for GvHD prevention and treatment.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Adrenal Cortex Hormones / therapeutic use
  • Calcineurin Inhibitors
  • Chronic Disease / drug therapy
  • Cyclosporine / therapeutic use
  • Graft vs Host Disease / drug therapy*
  • Graft vs Host Disease / prevention & control*
  • Graft vs Leukemia Effect / drug effects
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Methotrexate / therapeutic use
  • Methylprednisolone / therapeutic use
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • Risk Assessment
  • T-Lymphocytes / physiology
  • Tacrolimus / therapeutic use


  • Adrenal Cortex Hormones
  • Calcineurin Inhibitors
  • Immunosuppressive Agents
  • Cyclosporine
  • Mycophenolic Acid
  • Tacrolimus
  • Methylprednisolone
  • Methotrexate