Manipulating the Immunologic Characteristics of Both Graft and Host to Improve Transplant Outcome

Abstract

Background Several critical outcomes of allogeneic stem cell transplantation for hematologic malignancies such as engraftment, incidence of graft-vs-host disease (GVHD) and disease-free survival depend on a balance between residual host and infused donor T cells and on chemosensitivity of the underlying disorder. Manipulating cell compartments of the allograft does affect long-term outcome. Methods The authors review investigations on the effect of blood and marrow graft components, treatment regimens, and immunologic interventions on eventual transplant outcome, an approach termed “graft engineering.” Results Major advances in graft engineering over the last decade are presented as a series of related developments or levels that derive from the goals of reducing GVHD and minimal residual disease. Conclusions Morbidity and mortality of GVHD have decreased markedly by methods of T-cell depletion but at the expense of recurrent disease. Cellular therapy and immunotherapy show promise in potentially eradicating residual disease posttransplant.