Travnik R, Beckers M, Wolff D, Holler E, Landthaler M, Karrer S
Klinik und Poliklinik für Dermatologie, Universität Regensburg.
Hautarzt. 2011 Mar;62(3):229-37; quiz 238-9. doi: 10.1007/s00105-010-2118-1.
Graft-versus-host disease (GvHD) remains one of the major complications after allogeneic stem cell transplantation (SCT) and is responsible for morbidity, mortality and decrease in quality of life of patients after SCT. The most important preventive approach is the selection of a donor with best possible HLA compatibility between donor and recipient. Basic prophylaxis of acute GvHD begins already prior to transplantation and usually consists of cyclosporine with or without methotrexate. In the past few years, many new therapies have been introduced for the treatment of acute and chronic GvHD. Extracorporeal photopheresis (ECP), for example, represents a promising treatment option for acute and chronic GvHD with very few side effects. For chronic GvHD mTOR inhibitors (sirolimus, everolimus) may replace calcineurin-inhibitors with the advantage of not inducing malignant skin tumors. Guidelines are available ort he management of acute and chronic GvHD. While pathophysiology, classification and skin manifestations of GvHD have been already presented in the first part of this article, this second part covers the prognosis, prevention and treatment of GvHD.
移植物抗宿主病（GvHD）仍然是异基因干细胞移植（SCT）后的主要并发症之一，它导致SCT后患者发病、死亡以及生活质量下降。最重要的预防方法是选择供体与受体之间HLA相容性尽可能最佳的供体。急性GvHD的基础预防在移植前就已开始，通常包括使用或不使用甲氨蝶呤的环孢素。在过去几年中，已经引入了许多用于治疗急性和慢性GvHD的新疗法。例如，体外光化学疗法（ECP）是治疗急性和慢性GvHD的一种有前景的治疗选择，副作用很少。对于慢性GvHD，mTOR抑制剂（西罗莫司、依维莫司）可能会取代钙调神经磷酸酶抑制剂，其优点是不会诱发恶性皮肤肿瘤。有关于急性和慢性GvHD管理的指南。虽然本文第一部分已经介绍了GvHD的病理生理学、分类和皮肤表现，但第二部分涵盖了GvHD的预后、预防和治疗。
