Vogelsang G B, Hess A D, Santos G W
Johns Hopkins Bone Marrow Unit, Johns Hopkins Hospital, Baltimore, Maryland 21205.
Medicine (Baltimore). 1988 May;67(3):163-74. doi: 10.1097/00005792-198805000-00003.
Graft-versus-host disease (GVHD) remains the major problem in allogeneic bone marrow transplantation. GVHD has limited the use of this technique to HLA-matched donor recipient pairs. Thus, only a quarter of patients who ultimately may have benefited from bone marrow transplantation are currently eligible. Even in matched patient recipient pairs, GVHD accounts for approximately 40% of the deaths following allogeneic bone marrow transplants. One of the major challenges for transplantation is to derive better strategies to prevent and treat GVHD while retaining the allogeneic benefit of graft-versus-leukemia. Current pharmacologic approaches have used cyclosporine, usually in combination with other drugs. More experimental approaches have removed lymphocytes from the marrow grafts. With either approach, maintaining the anti-leukemic benefit of an allogeneic transplant (i.e., immunologic attack of the leukemia resulting in a lower relapse rate), will need to be maintained if that approach will ultimately prove to be useful.
移植物抗宿主病（GVHD）仍然是异基因骨髓移植中的主要问题。GVHD限制了该技术仅用于人类白细胞抗原（HLA）匹配的供体-受体配对。因此，目前只有四分之一最终可能从骨髓移植中受益的患者符合条件。即使在匹配的患者-受体配对中，GVHD也占异基因骨髓移植后死亡人数的约40%。移植的主要挑战之一是制定更好的策略来预防和治疗GVHD，同时保留移植物抗白血病的异基因益处。目前的药物治疗方法通常使用环孢素，并通常与其他药物联合使用。更多的实验方法是从骨髓移植物中去除淋巴细胞。无论采用哪种方法，如果该方法最终被证明是有用的，都需要维持异基因移植的抗白血病益处（即对白血病的免疫攻击导致较低的复发率）。
