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Graft-vs-Host Disease

Has Any Progress Been Made in the Past Decade?

  • Chapter
Current Controversies in Bone Marrow Transplantation

Part of the book series: Current Clinical Oncology ((CCO))

Abstract

The transplantation of healthy hematopoietic stem cells into a patient with aplastic anemia or leukemia is potentially curative therapy, but the development of acute graftvs-host disease (GVHD), which often occurs even when the donor and recipient are siblings fully matched at the human leukocyte antigen (HLA) loci, significantly limits survival.The first descriptions of acute GVHD, following allogeneic bone marrow transplant (allo-BMT) in humans, were made in the 1960s. Significant strides in prophylaxis of acute GVHD have been made over the past four decades by the use of pharmacologic agents such as methotrexate (MTX) and cyclosporine (CSP), and by manipulation of the donor cell inoculum, to limit the infusion of effector donor lymphocytes. However, given the extensive clinical observations and investigations on the nature of this complication, it is remarkable that the diagnosis of acute GVHD is still clinically challenging, and that this complication continues to pose a formidable obstacle to successful allogeneic hematopoietic stem cell transplantation (allo-HSCT). On the other hand, patients with GVHD have improved leukemia-free survival (the graft-vsleukemia effect [GVL]) and this graft-vs-malignancy effect, a beneficial byproduct of the alloreactivity of the donor cells, may extend to lymphomas, myeloma, and even solid tumors (1–4). Thus, a major question in HSCT biology is how to preserve a graft-vs-malignancy effect, while eliminating GVHD. This chapter reviews some of the critical issues in the clinical manifestations and pathobiology of GVHD, including the results of recent investigations using an in vitro lymphocyte–skin adhesion assay to better define the mechanisms of GVHD. Advances during the past decade, in the prevention and treatment of GVHD, including recent evidence for a role of cellular modulation of GVHD, are also reviewed.

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Authors
  1. Thomas R. Spitzer MD
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  2. Robert Sackstein MD PhD
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Editors and Affiliations

  1. Bone Marrow Transplant Program, Department of Hematology/Medical Oncology, The Cleveland Clinic Foundation, Cleveland, OH, USA

    Brian J. Bolwell MD (Director, Staff Physician) (Director, Staff Physician)

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© 2000 Humana Press Inc., Totowa, NJ

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Spitzer, T.R., Sackstein, R. (2000). Graft-vs-Host Disease. In: Bolwell, B.J. (eds) Current Controversies in Bone Marrow Transplantation. Current Clinical Oncology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-657-7_17

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  • DOI: https://doi.org/10.1007/978-1-59259-657-7_17

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4684-9812-7

  • Online ISBN: 978-1-59259-657-7

  • eBook Packages: Springer Book Archive

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