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Graft-versus-host disease: recent advances including the use of photopheresis

Purpose of reviewThis review covers recent advances in the understanding of the pathophysiology of graft-versus-host disease (GvHD), predictive factors for GvHD, prophylaxis and treatment of acute GvHD, pathophysiology of chronic GvHD, and predictive factors for chronic GvHD. We conclude with a special section on the uses of photopheresis in GvHD. Recent findingsThe greatest progress during the review period was made in identification of genetic factors in addition to the HLA typing that contribute to the risk of developing GvHD. These genetic factors include minor histocompatibility antigens and polymorphisms in cytokines and other immunologically active molecules. Also, the evolving role of photopheresis in prevention and treatment of GvHD has received considerable attention. SummaryOur ability to give a patient an accurate risk assessment for GvHD is improving. Likewise, novel approaches to GvHD prevention and treatment are allowing for more intensive regimens for patients at greater risk. The ultimate goal of individualizing therapy based on risk has not yet been achieved, but this goal is in sight.