The immunobiology and clinical management of acute graft versus host disease after allogeneic transplant
OA Version
Citation
Abstract
Alloreactivity between donor cells against disparate host tissue is a natural and normal physiologic phenomenon after engraftment. Consequently, GVHD is a universally expected side effect after allogeneic HSCT. An effective strategy to prevent severe or fatal acute GVHD is require if the transplant is to be successful.
The HSCT field has witnessed significant progress in the prevention and treatment of acute GVHD. However, select interventions come at the cost of losing the alloimmune activity that prevents relapse, the GVL effect, as many of the mechanisms which cause GVHD are shared with those responsible for GVL. Current efforts are focused on therapeutic interventions that not only alleviate the burden of acute GVHD but does so in a way that maintains the GVL effect.
This review will provide an up-to-date overview of our current understanding of the diagnosis, risk stratification, immunobiology of acute GVHD, summarize efforts to prevent and treat the disease, and provide a perspective on future directions.