title: Acute graft-versus-host disease: are we close to bringing the bench to the bedside?
abstract: Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplant (AHSCT) associated with significant morbidity and mortality. This review focuses on the pathophysiology, prevention, and treatment of acute GVHD. Specifically, we explain how new discoveries in immunology have expanded our understanding of GVHD, in which tissue damage from chemotherapy or radiation results in cytokine release, activating T cells, resulting in proliferation and differentiation, trafficking to target organs, and tissue destruction and inflammation. Insights into the mechanisms of this disease relate directly to the development of preventive strategies and therapies, such as immunosuppression, calcineurin inhibitors, T-cell depletion, CCR5 antagonists, gut decontamination, extracorporeal photopheresis, and more. Understanding the immunobiology of GVHD and developing effective preventions and treatments are critical to the continuing success of AHSCT.
authors.affiliation: Duke University Medical Center, Division of Hematologic Malignancies and Cellular Therapy, 2400 Pratt St, Suite 9100, Box 3961, Durham, NC 27710, USA. Electronic address: anthony.sung@duke.edu.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Sung
authors.forename: Nelson J
authors.initials: NJ
authors.lastname: Chao
mesh_terms: D065100:CCR5 Receptor Antagonists; D019703:Calcineurin / Q000378:metabolism; D065095:Calcineurin Inhibitors; D049109:Cell Proliferation / Q000187:drug effects; D016207:Cytokines / Q000096:biosynthesis / Q000378:metabolism; D005938:Glucocorticoids / Q000627:therapeutic use*; D006086:Graft vs Host Disease / Q000276:immunology / Q000473:pathology / Q000517:prevention & control / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007165:Immunosuppression Therapy; D008213:Lymphocyte Activation; D008212:Lymphocyte Depletion; D017893:Photopheresis; D019713:Receptors, CCR5 / Q000378:metabolism; D013601:T-Lymphocytes / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D014184:Transplantation, Homologous
chemical_list: D065100:CCR5 Receptor Antagonists; C584933:CCR5 protein, human; D065095:Calcineurin Inhibitors; D016207:Cytokines; D005938:Glucocorticoids; D007155:Immunologic Factors; D019713:Receptors, CCR5; D019703:Calcineurin
keywords: AHSCT; CCR5 antagonists; GVHD; T-cell depletion; allogeneic hematopoietic stem cell transplant; calcineurin inhibitors; extracorporeal photopheresis; graft-versus-host disease; gut decontamination; immunosuppression; pathophysiology; prevention; treatment