Premium
Management of acute graft‐ versus ‐host disease
Author(s) -
Bacigalupo Andrea
Publication year - 2007
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2007.06533.x
Subject(s) - medicine , graft versus host disease , immunology , disease , stem cell , transplantation , hematopoietic stem cell transplantation , incidence (geometry) , regimen , complication , clinical trial , genetics , physics , optics , biology
Summary Acute graft‐ versus ‐host disease (GvHD) is a frequent complication of allogeneic haemopoietic stem cell transplantation (HSCT) and donor lymphocyte infusions (DLI). Its incidence and severity depends on several factors, such as prophylaxis method, donor/recipient matching, intensity of the conditioning regimen and composition of the graft. Significant progress has been made in recent years in understanding the pathogenesis of the disease, and some of these advances have been translated into clinical trials. First‐line treatment of acute GvHD is based on corticosteroids, and produce sustained responses in 50–80% of patients depending on the initial severity. Non‐responders are offered second‐line therapy, with combinations of immunosuppressive agents, but 1‐year survival is 30% in most large trials. New strategies explored include infusion of expanded mesenchymal stem cells (MSC), down regulation of antigen‐presenting cells (APC) and suicide gene transduced T cells. Acute GvHD is complicated by severe immunodeficiency causing life‐threatening infections. To date, GvHD has not been differentiated from the graft‐ versus ‐leukaemia effect. The present review will discuss some of these aspects.