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Graft-versus-Host-Erkrankung

Graft-versus-host disease

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Zusammenfassung

Die Graft-versus-Host-Erkrankung („graft-versus-host disease“, GvHD) – der dem Englischen entsprechende deutsche Begriff „Spender-gegen-Wirt-Erkrankung“ wird im deutschen Sprachraum eigentlich nicht mehr verwendet – ist eine häufige immunologische Unverträglichkeitsreaktion im Rahmen der allogenen hämatopoetischen Stammzelltransplantation und die wichtigste Ursache der transplantatassoziierten Morbidität und Mortalität. Ihre Inzidenz und Schwere sind von verschiedenen Faktoren abhängig, wie HLA-Übereinstimmung, Alter des Spenders, Behandlung des Transplantats u.v.m. Das zunehmende Verständnis der Pathophysiologie der GvHD wurde teilweise in prophylaktische und therapeutische Maßnahmen umgesetzt, die z. T. klinisch evaluiert werden. Der vorliegende Übersichtsartikel fasst Klassifikation, Diagnostik und therapeutische Konzepte zusammen. Pathophysiologische Mechanismen der GvHD-Entstehung werden nur insofern aufgeführt, wie sie zum Verständnis von in der klinischen Praxis verwendeten Therapieansätzen notwendig erscheinen.

Abstract

Graft-versus-host disease (GvHD) is the most important cause for transplant-related morbidity and mortality after hematopoietic stem cell transplantation. Its incidence and severity depend on several factors, such as HLA matching, donor age, source of the graft, and graft manipulation. Significant progress has been made in understanding the pathophysiology of this complication and some of these findings have been implemented in prophylactic or therapeutic approaches that are currently under clinical evaluation. This review summarizes important diagnostic features of GvHD, gives and overview of prophylactic concepts, outlines effective treatment concepts and comments briefly on some innovative therapeutic approaches for patients who fail first line therapy.

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Danksagung

Die histologischen Bilder von GvHD-Präparaten wurden freundlicherweise von Dr. F. Länger, Institut für Pathologie der Medizinischen Hochschule Hannover, zur Verfügung gestellt.

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  1. Abteilung für Pädiatische Hämatologie und Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625 , Hannover, Deutschland

    M. Sauer

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Sauer, M. Graft-versus-Host-Erkrankung. Monatsschr Kinderheilkd 155, 1021–1030 (2007). https://doi.org/10.1007/s00112-007-1612-8

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