Department of Pediatrics, Blood and Marrow Transplant Program, University of Michigan Medical School, 1500 E. Medical Center Drive, 6303 Comprehensive Cancer Center, Ann Arbor, MI 48109-5942, USA.
Immunol Allergy Clin North Am. 2010 Feb;30(1):75-101. doi: 10.1016/j.iac.2009.10.001.
Allogeneic hematopoietic cell transplantation (HCT) is an important therapeutic option for various malignant and nonmalignant conditions. As allogeneic HCT continues to increase, greater attention is given to improvements in supportive care, infectious prophylaxis, immunosuppressive medications, and DNA-based tissue typing. However, graft versus host disease (GVHD) remains the most frequent and serious complication following allogeneic HCT and limits the broader application of this important therapy. Recent advances in the understanding of the pathogenesis of GVHD have led to new approaches to its management, including using it to preserve the graft versus leukemia effect following allogeneic transplant. This article reviews the important elements in the complex immunologic interactions involving cytokine networks, chemokine gradients, and the direct mediators of cellular cytotoxicity that cause clinical GVHD, and discusses the risk factors and strategies for management of GVHD.
同种异体造血细胞移植（HCT）是治疗各种恶性和非恶性疾病的重要选择。随着同种异体 HCT 的不断增加，人们越来越关注支持性护理、感染预防、免疫抑制药物和基于 DNA 的组织分型的改善。然而，移植物抗宿主病（GVHD）仍然是同种异体 HCT 后最常见和最严重的并发症，限制了这一重要治疗方法的更广泛应用。对 GVHD 发病机制的理解的最新进展为其管理提供了新的方法，包括在同种异体移植后利用其保留移植物抗白血病效应。本文综述了细胞因子网络、趋化因子梯度和引起临床 GVHD 的细胞毒性直接介质的复杂免疫相互作用中的重要因素，并讨论了 GVHD 的危险因素和管理策略。
