Summary

 Acute graft-versus-host disease (GVHD) is a major source of morbidity and mortality after allogeneic stem cell transplantation. Therapy of established acute GVHD depends heavily on corticosteroids, which have limited efficacy and are considerably toxic. It is still a matter of debate whether there is an alternative therapy to corticosteroids. Second-line treatment for acute GVHD after failure of steroids is not well substantiated due to the lack of controlled studies. This review examines the current treatment for acute GVHD, as well as novel therapeutics, such as cellular approaches (e.g., adoptive transfer of mesenchymal stem cells) and enhancement of regulatory T cells (e.g., photopheresis). These approaches avoid the toxicity of generalized immunosuppression and are likely to play a prominent future role in acute GVHD therapy.