Graft-versus-host disease

Abstract

Purpose of review While allogeneic hematopoietic stem cell transplantation (allo-SCT) is potentially curative for a number of hematologic malignancies, its use is limited by the development of acute and chronic graft-versus-host disease (GVHD). This potentially fatal complication occurs in approximately 50% of allo-SCT recipients. Its pathogenesis is poorly understood, methods to prevent it are largely unchanged over the past two decades, and response to front-line treatment with corticosteroids is suboptimal. Recent findings The pathogenesis of acute and chronic GVHD remains poorly understood, methods to prevent it are largely unchanged over the past two decades, and response to front-line treatment with corticosteroids is suboptimal. For patients with steroid-refractory disease, response to second-line treatment is dismal. The prospective clinical studies evaluating new agents for GVHD have been hampered by inconsistencies in design, making generalization difficult, and few multicenter studies have been conducted. Summary Advances have been made over the past decade in grading both acute and chronic GVHD, with the development of biomarkers that provide improved prognostic information in acute GVHD and NIH Consensus Criteria for improved grading of chronic GVHD. This, along with the broad understanding of the need to conduct prospective studies with uniform inclusion criteria and endpoints leading to multicenter studies will hopefully lead to advancements in the prevention of GVHD in the near future.

Graft-versus-host disease affecting oral cavity. A review

“…The immunopathogenic mechanism of the disease is not entirely clear, though it is known that donor T cell reactivity against the recipient tissues, in the form of exacerbated direct or indirect inflammatory responses, is the main triggering factor of GVHD ( 4 , 17 ). Although there are common risk factors, the existence of certain risk factors that are exclusive of each type of GVHD suggests that the underlying pathogenesis also differs among them.…”

“…Although the epidemiological information referred to GVHD is not homogeneous, it has been estimated that almost one-half of all patients subjected to hematopoietic stem cell transplantation will develop the disease ( 4 , 7 ). The prevalence of cGVHD among those who survive over 100 days after transplantation is 25-80% ( 2 , 14 ).…”

“…Considering that no specific drug therapy for GVHD has yet been approved by the United States Food and Drug Administration (FDA)( 4 ), the effectiveness of treatment can be expected to be limited. Furthermore, cGVHD and its treatment are associated to different complications such as secondary infections, osteoporosis, hypertension, hyperglycemia, renal failure and hyperlipidemia ( 28 ).…”

“…The drugs of choice for the treatment of cGVHD are corticosteroids (class A recommendation, level of evidence Ia) with or without calcineurin inhibitors (C-1, IIa)( 2 - 4 , 14 , 17 , 18 ). Prednisone is recommended at a dose of 1 mg/kg/day during two weeks, followed by 1 mg/kg on alternate days during four weeks if cGVHD remains stable or improves.…”

“…Allogenic hematopoietic stem cell transplantation (HSCT) is widely used for the treatment of different benign and malignant hematological diseases. In this context, GVHD is one of the most frequent and serious complications of HSCT, and is regarded as the leading cause of late mortality unrelated to the underlying disease process ( 2 - 4 ). Indeed, GVHD is one of the main reasons why HSCT is not used as often as would be desirable ( 5 , 6 ).…”