Acute graft-vs-host disease: pathobiology and management

Area of Science:

• Immunology
• Hematology
• Oncology

Background:

• Acute graft-vs-host disease (GVHD) is a significant cause of morbidity and mortality following allogeneic hematopoietic stem cell transplantation (HSCT).
• GVHD arises from donor T lymphocyte reactions against host cells, leading to widespread tissue injury.

Purpose of the Study:

• This review synthesizes the pathobiological mechanisms, clinical manifestations, and current therapeutic strategies for acute GVHD.
• To provide an overview of the current landscape and future directions in acute GVHD management.

Main Methods:

• The review discusses the afferent phase, involving conditioning-induced tissue damage and host antigen presentation, and the effector phase, characterized by direct and indirect host cell damage.
• Key target organs including skin, gastrointestinal tract, and liver are highlighted.

Main Results:

• Current prophylaxis involves combination drug regimens, with steroids remaining the standard treatment for established acute GVHD.
• Therapies for steroid-resistant GVHD, including monoclonal antibodies and receptor antagonists, show variable success.
• Emerging agents like mycophenolate mofetil and rapamycin are under investigation.

Conclusions:

• Effective GVHD prophylaxis and treatment are crucial for safe allogeneic HSCT.
• Ongoing research aims to develop strategies for GVHD prevention, enabling enhanced graft-vs-tumor effects with reduced GVHD complications.