National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2020 Etiology and Prevention Working Group Report.

National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2020 Etiology and Prevention Working Group Report.
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美国国立卫生研究院关于慢性移植物抗宿主病临床试验标准的共识发展项目:I.2020年病因学和预防工作组报告。

DOI:
10.1016/j.jtct.2021.02.035
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发表时间:
2021-06
影响因子:
3.2
通讯作者:
Sarantopoulos S
Sarantopoulos S
中科院分区:
医学2区
文献类型:
--
作者:
Williams KM;Inamoto Y;Im A;Hamilton B;Koreth J;Arora M;Pusic I;Mays JW;Carpenter PA;Luznik L;Reddy P;Ritz J;Greinix H;Paczesny S;Blazar BR;Pidala J;Cutler C;Wolff D;Schultz KR;Pavletic SZ;Lee SJ;Martin PJ;Socie G;Sarantopoulos S

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预防慢性移植物抗宿主病(GVHD)仍然具有挑战性,因为对引发慢性GVHD的独特细胞和分子途径知之甚少。潜在预防慢性GVHD的一个主要干预点发生在移植时,此时急性供体抗受体免疫应答首先启动导致慢性GVHD的事件。移植后,引起组织损伤的额外损伤可激发异常免疫应答和耐受性丧失,进一步促成慢性GVHD。正在积极确定干预点,以便在不影响免疫功能的情况下靶向慢性GVHD起始途径。该领域的主要目标是继续进行基础研究,并将有关病因学的知识转化为有针对性的预防策略,以降低病态慢性GVHD的风险,而不增加癌症复发或感染的风险。发展战略,以预测发展衰弱或致命的慢性GVHD的风险是一个高度优先的研究。该工作组建议进一步探究慢性GVHD发展的机制,我们强调了预防试验中未来试验设计的考虑因素。
Preventing chronic graft versus host disease (GVHD) remains challenging because the unique cellular and molecular pathways that incite chronic GVHD are poorly understood. One major point of intervention for potential prevention of chronic GVHD occurs at the time of transplantation when acute donor anti-recipient immune responses first set the events in motion that result in chronic GVHD. After transplantation, additional insults causing tissue injury can incite aberrant immune responses and loss of tolerance further contributing to chronic GVHD. Points of intervention are actively being identified so that chronic GVHD initiation pathways can be targeted without affecting immune function. The major objective in the field is to continue basic studies and to translate what is learned about etiopathology to develop targeted prevention strategies that decrease the risk of morbid chronic GVHD without increasing the risks of cancer relapse or infection. Development of strategies to predict risk of developing debilitating or deadly chronic GVHD is a high research priority. This Working Group recommends further interrogation into mechanisms underpinning chronic GVHD development, and we highlight considerations for future trial design in prevention trials.
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