194 soma non sono stati confermati in 2 studi prospettici [23,25]. Più robusti sembrano i dati sul sirolimus , inibitore di mTor, che sembra ridurre la GvHD acuta e migliorare la sopravvivenza con la peculiarità di preservare i Tregs [26-30]. Nuovi approcci ancora in fase di studio ma con dati incoraggianti stanno valutando la manipolazione degli immune checkpoints (abatacept [31] )e il blocco del traffico T linfocitario (vedolizumab [32] e maraviroc [33]). L’inibizione di citochine infiammatorie (tocilizumab [34], antagonisti del recettore di IL1 [35] e anti TNFα [36-37] ) non ha dato i risultati sperati. Infne il reindirizzamento della polarizzazione delle cellule T attraverso la somminsitrazione di modificatori epigenetici (vorinostat) sembrebbe poter avere un ruolo nella profilassi dell GvHD [38-39], ma mancano dati prospettici. Bibliografia [1] Penack O, Marchetti M,Ruutu T et al. 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