Therapeutic strategy for post-transfusion graft-vs.-host disease

An effective treatment for post-transfusion graft-vs.-host disease (PT-GVHD ), a fatal complication of blood transfusion, has not yet been identified. In this review, we propose a treatment for PT-GVHD based on the mechanism o f its onset. First, we briefly review the findings that PT-GVHD is induced by cytotoxic T-lymphocyte (CTL)-mediated tissue injuries through the Fas/Fa s ligand system, the perforin/granzyme system, and alloantigen-specific ant ibodies, as well as through inflammatory cytokines. Secondly: we emphasize the usefulness of a serine protease inhibitor for the inhibition of CTL-med iated cytotoxicity in the earlier stages of onset. Subsequent administratio n of methylprednisolone and 2-chlordeoxyadenosine is recommended for elimin ation of the donor's lymphocytes. The usefulness of chloroquine for the sup pression of CTL activity and the production of tumor necrosis factor as wel l as the efficiency of pentoxyfylline for the suppression of the production of tumor necrosis factor are also discussed. Therapeutic strategies for PT -GVHD should also be useful for treating acute GVHD secondary to allogeneic bone marrow transplantation, and to prevent the host's rejection of transp lanted organs as well as tissue damage in autoimmune diseases. (C) 1999 The Japanese Society of Hematology.