Evolving strategies to address adverse transplant outcomes associated with T cell depletion.

Graft-versus-host disease (GVHD) is the major complication of allogeneic bone marrow transplantation (BMT). The most effective strategy to reduce GVHD has been T cell depletion (TCD) of the donor marrow graft. Although TCD has reduced both the incidence and severity of GVHD, it has been associated with an increased rate of graft rejection and an impairment in immune reconstitution after transplant. Relapse rates in selected hematologic malignancies have also been higher after TCD allogeneic BMT. Over the past several years, a number of clinical strategies have been developed in an effort to reduce adverse transplant outcomes associated with TCD. This review examines some of the strategies designed to promote alloengraftment, prevent relapse, and enhance immune reconstitution after TCD.