[Recent progress in treatment and prophylaxis of graft-versus-host disease]

Graft-versus-host disease (GVHD) is one of major causes of mortality in allogeneic bone marrow transplantation (BMT). GVHD prophylaxis for HLA matched sibling BMT is widely done by methotrexate and/or cyclosporine. More intensive modalities are necessary for HLA mismatched related or HLA matched unrelated BMT; T cell depletion, ALG/ATG in preconditioning or following BMT and FK-506 with short term methotrexate are currently used with certain success. Moderate to severe GVHD may develop despite of these preventions, and standard to high dose of steroid with or without ALG/ATG is currently used as the first line therapy. GVHD, however, is an important component to cure malignant diseases through its anti-tumor effect called graft-versus-leukemia (GVL) effect. Several attempts have been made to induce mild to moderate GVHD both in allogeneic and in autologous BMT; low dose of cyclosporine, IL-2, ubenimex and donor buffy coat or peripheral lymphocyte transfusion are shown to be effective with some limitation.