Strategies for Enhancing and Preserving Anti-leukemia Effects Without Aggravating Graft-Versus-Host Disease

• Published in: Frontiers in immunology Vol. 9; p. 3041
• Main Authors: Chang, Ying-Jun, Zhao, Xiang-Yu, Huang, Xiao-Jun
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 21.12.2018
• Subjects: allogeneic stem cell transplantation; Allografts - drug effects; Allografts - immunology; Animals; Clinical Trials as Topic; Disease Models, Animal; Donor Selection; G-CSF; Graft vs Host Disease - immunology; Graft vs Host Disease - prevention & control; Graft vs Leukemia Effect - immunology; graft-versus-host disease; graft-versus-leukemia; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Immunologic Factors - administration & dosage; Immunology; Immunotherapy, Adoptive - methods; Killer Cells, Natural - immunology; Leukemia - immunology; Leukemia - pathology; Leukemia - therapy; Mice; Neoplasm Recurrence, Local - immunology; Neoplasm Recurrence, Local - prevention & control; Receptors, Chimeric Antigen - immunology; relapse; T-Lymphocytes - immunology; T-Lymphocytes - transplantation; Transplantation Conditioning - methods; Transplantation, Homologous - adverse effects; allogeneic stem cell transplantation; relapse; G-CSF; graft-versus-host disease; graft-versus-leukemia
• ISSN: 1664-3224; 1664-3224
• DOI: 10.3389/fimmu.2018.03041

Allogeneic stem cell transplantation (allo-SCT) is a curable method for the treatment of hematological malignancies. In the past two decades, the establishment of haploidentical transplant modalities make "everyone has a donor" become a reality. However, graft-versus-host disease (GVHD) and relapse remain the major two causes of death either in the human leukocyte antigen (HLA)-matched transplant or haploidentical transplant settings, both of which restrict the improvement of transplant outcomes. Preclinical mice model showed that both donor-derived T cells and natural killer (NK) cells play important role in the pathogenesis of GVHD and the effects of graft-versus-leukemia (GVL). Hence, understanding the immune mechanisms of GVHD and GVL would provide potential strategies for the control of leukemia relapse without aggravating GVHD. The purpose of the current review is to summarize the biology of GVHD and GVL responses in preclinical models and to discuss potential novel therapeutic strategies to reduce the relapse rate after allo-SCT. We will also review the approaches, including optimal donor selection and, conditioning regimens, donor lymphocyte infusion, BCR/ABL-specific CTL, and chimeric antigen receptor-modified T cells, which have been successfully used in the clinic to enhance and preserve anti-leukemia activity, especially GVL effects, without aggravating GVHD or alleviate GVHD.