Opportunities for Therapies for Graft-Versus-Host Disease Following Hematopoietic Stem Cell Transplantation: Is Africa Prepared?

Abstract

Hematopoietic stem cell transplantation is a therapeutic approach used to cure many malignant and non-malignant, acquired and congenital/genetic as well as benign disorders of the bone marrow. This procedure is considered to be among the major advances of modern medicine which has been marked by a growing need globally. Graft-versus-host disease (GVHD) and failure of engraftment continues to be major hurdles to the success of allogeneic hematopoietic stem cell transplantation (HSCT) as well as adoptive T cell causing high morbidity and mortality.  The limited understanding of the pathogenesis of acute and chronic GvHD, coupled with the suboptimal response to front-line corticosteroid treatment and poor outcomes for patients with steroid-refractory disease, present major hurdles. Additionally, the inconsistencies in the design of prospective clinical studies evaluating new agents for GvHD have hindered progress, with few multicenter studies being conducted. While advancements have been made in grading GvHD and developing biomarkers for improved prognostic information, there is a critical need for uniform inclusion criteria and endpoints in prospective studies to facilitate multicenter research and advancements in GvHD prevention. In developing countries, HSCT is further limited by high cost, limited infrastructure, availability of HLA-identical donors and management of complications such as GvHD. Several modalities have been employed to curb GvHD such as (drugs), additional inventions have been employed that include molecular methods that will be described in this review.