Immune Suppression in Allogeneic Hematopoietic Stem Cell Transplantation.
Immune Suppression in Allogeneic Hematopoietic Stem Cell Transplantation.
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DOI：
10.1007/164_2021_544
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发表时间：
2022
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异基因造血干细胞移植（allo-HSCT）是治疗高危血液病的有效方法。allo-HSCT后有多种免疫介导的并发症，可通过免疫抑制剂预防和/或治疗。这些免疫介导的并发症中的主要是急性移植物抗宿主病（aGVHD），其发生在新供体免疫系统靶向宿主组织抗原时。aGVHD的免疫生物学是复杂的，涉及免疫系统的所有方面。由于aGVHD的风险，几乎所有同种异体HSCT受者都需要免疫抑制性aGVHD预防。尽管预防，aGVHD仍然是非复发死亡率的主要原因。在这里，我们讨论了aGVHD的临床特征，aGVHD的免疫生物学，用于预防和治疗aGVHD的免疫抑制疗法，如何减轻这些免疫抑制疗法的副作用，以及免疫抑制治疗的其他免疫介导的allo-HSCT后并发症。
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative treatment for high-risk hematologic disorders. There are multiple immune-mediated complications following allo-HSCT that are prevented and/or treated by immunosuppressive agents. Principal among these immune-mediated complications is acute graft-versus-host disease (aGVHD), which occurs when the new donor immune system targets host tissue antigens. The immunobiology of aGVHD is complex and involves all aspects of the immune system. Due to the risk of aGVHD, immunosuppressive aGVHD prophylaxis is required for nearly all allogeneic HSCT recipients. Despite prophylaxis, aGVHD remains a major cause of nonrelapse mortality. Here, we discuss the clinical features of aGVHD, the immunobiology of aGVHD, the immunosuppressive therapies used to prevent and treat aGVHD, how to mitigate the side effects of these immunosuppressive therapies, and what additional immune-mediated post-allo-HSCT complications are also treated with immunosuppression.