Acute Graft Versus Host Disease: A Comprehensive Review
| Autor: | Hind Rafei, Samah Nassereddine, Ehab El-Bahesh, Imad A. Tabbara |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Oncology Cancer Research medicine.medical_specialty medicine.medical_treatment 03 medical and health sciences 0302 clinical medicine Internal medicine Medicine business.industry Mesenchymal stem cell Hematopoietic stem cell Immunosuppression General Medicine medicine.disease Anti-thymocyte globulin Leukemia Regimen surgical procedures operative 030104 developmental biology medicine.anatomical_structure 030220 oncology & carcinogenesis Bone marrow Stem cell business |
| Zdroj: | Anticancer Research. 37:1547-1555 |
| ISSN: | 1791-7530 0250-7005 |
| DOI: | 10.21873/anticanres.11483 |
| Popis: | Acute graft versus host disease (aGVHD) remains the second leading cause of death following allogeneic hematopoietic stem cell transplant (AHSCT). Over the last five years, the progress in understanding the pathophysiology of this immune based-process helped redefine graft versus host reaction and opened new possibilities for novel preventive and therapeutic approaches. The evolution in the field of immunology widened the horizons for hematopoietic stem cell transplant leading to the availability of different stem cell sources for potential graft and incorporation of novel conditioning regimens. There is conflicting data about the impact of the graft source and the conditioning regimen used in the process of AHSCT on the incidence of aGVHD. Many studies have reported increased risk of chronic GVHD (cGVHD) and to a less extent aGVHD with the use of peripheral blood stem cell and bone marrow compared to umbilical cord stem cell. The conditioning regimen, either myeloablative, non-myeloablative or reduced intensity may have different impact on the incidence of GVHD. Several preventive modalities have been adopted by different transplant centers but, to date, there is no standardized regimen. As for treatment, immunosuppression using steroids remains the first line of intervention. Several novel therapeutic options are being investigated for treatment of steroid-refractory aGVHD including the use of mesenchymal stem cells, anti thymocyte globulin and extra corporeal photophoresis. This review discusses the pathophysiology, risk factors, clinical features, and advances in the diagnosis, prevention and treatment of aGVHD. |
| Databáze: | OpenAIRE |
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