Acute graft-versus-host disease: pathophysiology, clinical manifestations, and management.
Hematopoietic stem cell transplantation has evolved as a central treatment modality in the management of different hematologic malignancies. Despite adequate posttransplantation immunosuppressive therapy, acute graft-versus-host disease (GVHD) remains a major cause of morbidity and mortality in the hematopoietic stem cell transplantation setting, even in patients who receive human leukemic antigen (HLA) identical sibling grafts. Up to 30% of the recipients of stem cells or bone marrow transplantation from HLA-identical related donors and most patients who receive cells from other sources (matched-unrelated, non-HLA-identical siblings, cord blood) will develop > Grade 2 acute GVHD despite immunosuppressive prophylaxis. Thus, GVHD continues to be a major limitation to successful hematopoietic stem cell transplantation. In this review, the authors summarize the most current knowledge on the pathophysiology, clinical manifestations, and management of this potentially life-threatening transplantation complication.
Couriel
Daniel
D
Department of Blood and Marrow Transplantation, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA. dcouriel@mdanderson.org
Caldera
Humberto
H
Champlin
Richard
R
Komanduri
Krishna
K
D000208:Acute Disease; D000938:Antigen-Presenting Cells / Q000502:physiology; D015704:CD4 Antigens / Q000032:analysis; D006086:Graft vs Host Disease / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008212:Lymphocyte Depletion; D015375:Receptors, Interleukin-2 / Q000032:analysis; D016176:T-Lymphocyte Subsets / Q000276:immunology
D015704:CD4 Antigens; D015375:Receptors, Interleukin-2