Ferrara James L M, Yanik Gregory
University of Michigan Medical School, 1500 E. Medical Center Drive, 6308 CCGC, Ann Arbor, MI 48109, USA.
Clin Adv Hematol Oncol. 2005 May;3(5):415-9, 428.
Acute graft versus host disease (GVHD) remains the greatest complication of allogeneic bone marrow transplantation and a major cause of morbidity and mortality. This article summarizes the risk factors and prevention strategies for acute GVHD by considering them within the context of disease pathophysiology. Acute GVHD can be considered a 3-step process: 1) damage from chemotherapy/radiotherapy; 2) host antigen-presenting cell activation and amplification of donor T cells; and 3) target cell apoptosis via cellular and inflammatory mediators. This conceptual framework helps to explain the effectiveness of current prevention strategies and points to areas where new drugs and approaches may be of clinical benefit.
急性移植物抗宿主病（GVHD）仍然是异基因骨髓移植最严重的并发症，也是发病和死亡的主要原因。本文通过在疾病病理生理学背景下考虑急性GVHD的危险因素和预防策略进行了总结。急性GVHD可被视为一个三步过程：1）化疗/放疗造成的损伤；2）宿主抗原呈递细胞激活和供体T细胞扩增；3）通过细胞和炎症介质导致靶细胞凋亡。这一概念框架有助于解释当前预防策略的有效性，并指出可能具有临床益处的新药和新方法的领域。
