Have we improved in preventing and treating acute graft-versus-host disease?
Have we improved in preventing and treating acute graft-versus-host disease?
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DOI：
10.1097/moh.0b013e32834b6196
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发表时间：
2011-11
影响因子：
3.2
通讯作者：
Pidala J
中科院分区：
文献类型：
--
作者：
Perez L;Anasetti C;Pidala J
急性移植物抗宿主病（GVHD）是异基因造血细胞移植（HCT）后发病率和死亡率的重要来源。因此，需要在该并发症的预防和主要治疗方面取得进展，以改善患者结局。在对急性GVHD发病机制的深入了解的指导下，研究人员已经探索了新的细胞和药理学方法来预防急性GVHD，这表明了希望。虽然泛T细胞耗竭减少了GVHD，但选择性耗竭同种异体反应性T细胞或调节效应T细胞和调节性T细胞平衡的新策略有望选择性消除急性GVHD，同时保留对原发性疾病复发和感染性并发症的保护。急性GVHD主要治疗的不同方法已经探索了标准剂量糖皮质激素和额外免疫抑制剂的联合方法，以及相反的类固醇节约方法，包括局部药物（例如倍氯米松或西罗莫司）作为急性GVHD治疗的无类固醇方法。需要高质量临床试验的成熟结果来确定有效控制该综合征并限制毒性的最佳疗法。这些互补的结果代表了急性GVHD治疗未来研究的治疗目标。
Acute graft vs. host disease (GVHD) is a considerable source of morbidity and mortality following allogeneic hematopoietic cell transplantation (HCT). Accordingly, progress in the prevention and primary therapy of this complication is needed to improve patient outcomes. Guided by insights into acute GVHD pathogenesis, investigators have explored novel cellular and pharmacologic approaches to acute GVHD prevention that demonstrates promise. While pan-T cell depletion has reduced GVHD, novel strategies that selectively deplete alloreactive T cells or modulate the balance of effector T cells and regulatory T cells offer promise to selectively abrogate acute GVHD while retaining protection from primary disease relapse and infectious complications. Divergent approaches in the primary therapy of acute GVHD have explored both combination approaches with standard dose glucocorticoids and additional immunosuppressive agents and conversely steroid-sparing approaches including topical agents such as beclomethasone or sirolimus as a steroid-free approach to acute GVHD therapy. Mature results of high quality clinical trials are needed to determine the optimal therapy that results in effective control of the syndrome and limited toxicity. These complementary outcomes represent the therapeutic goal for future investigation in acute GVHD therapy.