Zhou Ying, Chen Bao-An, Zhao Gang
Department of Hematology, Zhongda Hospital, Southeast University Clinical Medical College, Nanjing 210009, Jiangsu Province, China.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2010 Feb;18(1):238-41.
Acute graft-versus-host disease (aGVHD) is a common complication after allogeneic hematopoietic stem-cell transplantation. Despite improvements in understanding of transplant immunology, aGVHD remains to be a major cause of mortality for patients after allogeneic hematopoietic stem-cell transplantation. While systemic corticosteroid is standard primary therapy for aGVHD, there is no established standard treatment for patients in the steroid-refractory setting. Over the past decade, monoclonal antibodies, biologic engineering products, and chemotherapeutics with immunomodulatory effects are being used as novel therapies in this disease. Many of these agents, such as mycophenolate mofetil, anti-tumor necrosis factor antibodies, and anti-interleukin-2Ralpha-chain antibodies, have demonstrated promising activity in steroid-refractory aGVHD. But long-term survival remains poor due to a high incidence of infections. The key to improving aGVHD outcomes may, in fact, rest upon successful initial therapy, and timely taper corticosteroids to promote immune reconstitution. Clinical trials combining these newer agents with systemic corticosteroids as initial treatment are under way. In this article some new treatments for acute aGVHD are recommend and summarized.
急性移植物抗宿主病（aGVHD）是异基因造血干细胞移植后的常见并发症。尽管在移植免疫学的理解方面有所进步，但aGVHD仍然是异基因造血干细胞移植患者死亡的主要原因。虽然全身用皮质类固醇是aGVHD的标准初始治疗方法，但对于类固醇难治性患者尚无既定的标准治疗方法。在过去十年中，单克隆抗体、生物工程产品以及具有免疫调节作用的化疗药物正被用作该疾病的新型疗法。其中许多药物，如霉酚酸酯、抗肿瘤坏死因子抗体和抗白细胞介素-2Rα链抗体，在类固醇难治性aGVHD中已显示出有前景的活性。但由于感染发生率高，长期生存率仍然很低。事实上，改善aGVHD预后的关键可能在于成功的初始治疗，并及时减少皮质类固醇用量以促进免疫重建。将这些新型药物与全身用皮质类固醇联合作为初始治疗的临床试验正在进行中。本文推荐并总结了一些急性aGVHD的新治疗方法。
