Abstract
Despite modern matching techniques graft-versus-host disease (GVHD) remains one of the major complications of bone marrow transplantation (BMT). It occurs in up to 80% of patients receiving HLA-matched sibling BMT and is responsible directly or indirectly for about 20% of the mortality seen after BMT. Prevention and treatment of GVHD is only partially successful at present because of both the inefficiency and lack of specificity of treatment. Here the immunopathology of acute and chronic GVHD, and its relationship with infection, is discussed.
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References
Further Reading
Atkinson KA (1990) Chronic Graft-versus-host disease - review. Bone Marrow Transplant 5:69–82 This is an excellent review of the clinical and pathological features and treatment of chronic GVHD.
Bostrom L, Ringden O, Gratama JW et al. for the Leukaemia Working Party of the European Group for Bone Marrow Tranplantation (1990) A role of herpes virus serology for the development of acute graft-versus-host disease. Bone Marrow Transplant 5:321–326 A multicenter analysis confirming a strong association of prior herpes virus exposure in patient and donor on subsequent development of GVHD.
Dickenson AM, Sviland L, Dunn J, Carey P, Proctor SJ (1991) Demonstration of direct involvement of cytokines in graft-versus-host reactions using an in vitro human skin explant model. Bone Marrow Transplant 7:209–216 One of a series of studies using human skin explants to demonstrate histological changes of GVHD in vitro.
Lonnqvist B, Ringden O, Wahren B et al. (1984) Cytomegalovirus infection associated with and preceding chronic graft versus host disease. Transplantation 38:465–468 A multicentrer statistical review confirming the close association of GVHD with CMV infection.
Lum L (1987) The kinetics of immune reconstitution after human marrow transplan¬tation. Blood 69:369–380 A good review of the pattern of immune recovery after BMT and the impact of GVHD upon it.
Meyers JD, Red EC, Shepp DH et al. (1988) Acyclovir for prevention of cytomegalovirus infection and disease after allogeneic marrow transplantation. N Engl J Med 318: 70–75
Schmidt GM, Horak DA, Niland JC et al. (1991) A randomised controlled trial of prophylactic ganciclovir for cytomegalovirus pulmonary infection in recipients of allogeneic bone marrow transplants. N Engl J Med 324: 1005–1011
Storb R, Prentice R, Buckner CK et al. (1983) Graft-versus-host disease and survival in patients with aplastic anaemia treated by bone marrow grafts from HLA- identical siblings: beneficial effects of a protective environment. N Engl J Med 308: 302–307 This is one of the few studies to show that in clinical practice rigorous bacterial decontamination can affect GVHD incidence and severity.
van Bekkum DW, Roodenburg J, Heidt PJ, van der Waaij D (1974) Mitigation of secondary disease of allogeneic mouse radiation chimeras by modification of the intestinal microflora. J Natl Cancer Inst 52:401–414 The original observation that bacterial microflora predispose to GVHD.
Vogelsang GB, Wagner JE (1990) Graft-versus-host disease. Clin Hemato North Am 4:625–642 A recent review which extensively covers prevention and treatment approaches.
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© 1993 Springer-Verlag Berlin · Heidelberg
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Barrett, A.J. (1993). Graft-Versus-Host Disease: Basic Considerations. In: Schimpff, S.C., Klastersky, J. (eds) Infectious Complications in Bone Marrow Transplantation. Recent Results in Cancer Research, vol 132. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-84899-5_19
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DOI: https://doi.org/10.1007/978-3-642-84899-5_19
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