Separating antiviral and GVHD activities of donor T cells prior to bone marrow transplantation

Approaches to speed immune reconstitution following bone marrow transplantation (BMT) or peripheral-blood hematopoietic stem-cell transplantation (HSCT) could markedly reduce morbidity and mortality, particularly following partially major histocompatibility complex (MHC)-matched related donor (PMRD) transplants. However, it is critical to simultaneously eliminate the subpopulation of donor T cells that are alloreactive with the recipient and may produce graft-vs-host disease (GVHD). In this article, we discuss a number of promising cellular engineering approaches that could be applied to this problem, including the use of veto cells, regulatory T-cell subsets, and psoralen-treated donor lymphocytes. Emphasis is placed on whether these approaches can simultaneously transfer broad-spectrum immunity to the recipient without producing GVHD.