Acute graft-vs-host disease Pathobiology and management

摘要: Acute graft-vs-host disease (GVHD) is a major obstacle to safe allogeneic hematopoietic stem cell transplantation (HSCT), leading significant morbidity and mortality. GVHD occurs when transplanted donor T lymphocytes react foreign host cells. It causes wide variety of tissue injuries. This review focuses on the pathobiological basis, clinical aspects, current management strategies acute GVHD. Afferent phase starts with myeloablative conditioning, i.e., before infusion graft. Total-body irradiation (TBI) or high-dose chemotherapy regimens cause extensive damage activation in tissues, which release inflammatory cytokines enhance recipient histocompatibility complex (MHC) antigens. Recognition antigens by cells activation, stimulation, proliferation crucial afferent phase. Effector results direct indirect The skin, gastrointestinal tract, liver are target organs Combination drug prophylaxis essential all patients undergoing HSCT. Steroids have remained standard for treatment Several trials evaluated monoclonal antibodies receptor antagonist therapy steroid-resistant GVHD, different successes settings. There some newer promising agents like mycophenolate mofetil, glutamic acid-lysine-alanine-tyrosine (GLAT), rapamycin, trimetrexate currently entering studies, other development. Future experimental studies will shed further light better understanding pathobiology generate tools treat malignant disorders HSCT specific graft-vs-tumor effects devoid