graft-versus-host disease a surge of developments移植物抗宿主病的发展.pdfVIP

Research in Translation Graft-Versus-Host Disease: A Surge of Developments Stanley R. Riddell, Frederick R. Appelbaum* Introduction This year approximately 20,000 individuals will receive an allogeneic hematopoietic cell transplant (HCT) as treatment for a malignant, or life-threatening non-malignant, hematopoietic disease. The process of HCT generally begins with administration of a preparative regimen to eradicate the underlying disease and immunosuppress the patient in order to prevent rejection of the doi:10.1371/journal.pmed.0040198.g001 subsequently transfused hematopoietic Figure 1. Clinical Appearance of Acute Graft-Versus-Host Disease Involving the Skin and the stem cells. Following HCT, donor T Upper Intestinal Mucosa cells transplanted with or developing Left panel: The diffuse erythematous maculopapular rash typical of acute GVHD. Right panel: an from the hematopoietic stem cells endoscopic view of the edematous, reddened, friable gastrointestinal mucosa seen in a patient with acute GVHD. react with cells of the human leukocyte antigen (HLA)-matched but genetically non-identical host, providing a against GVHD [1]. In the mid-1980s, stem cell source. More intensive benefi cial graft-versus-tumor (GVT) prospective randomized trials were post-transplant immunosuppressive response but also resulting in possibly performed demonstrating that a regimens and T cell depletion are life-threatening graft-versus-host combination of a calcineurin inhibitor both capable of dramatically reducing disease (GVHD). The manifestations (cyclosporin or tacrolimus) plus the incidence and severity of GVHD, of GVHD v