Hartigan Christina R, McDonald-Hyman Cameron, Pavletic Steven Z, Blazar Bruce R
Division of Blood and Marrow Transplant and Cellular Therapy, Department of Pediatrics, University of Minnesota, Minneapolis, MN.
Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN.
Transplantation. 2025 Jun 24. doi: 10.1097/TP.0000000000005444.
Chronic graft-versus-host disease (cGVHD) is the leading cause of nonrelapse morbidity and mortality post-allogeneic hematopoietic stem cell transplant. Murine cGVHD models have laid the groundwork for the clinical translation of multiple recently Food and Drug Administration-approved therapies for second- and third-line treatments of patients with cGVHD. However, not all patients respond to these therapies, and in those that do, responses are often partial or transient. Significant gaps remain in our understanding of cGVHD biology, which limits our ability to develop additional and more precise therapeutics that can be used alone or in combination for treating patients with cGVHD. Current and future preclinical investigations focusing on disease mechanisms that are as yet unexplored will elucidate new pathways to be exploited for improving the outcomes of patients with cGVHD. This review focuses on preclinical data derived from cGVHD animal models with particular emphases on (1) cGVHD basic biology; (2) the utility of integrating preclinical data from mouse models and human samples for clinical translation; and (3) burgeoning areas of preclinical investigation which hold future therapeutic potential, including targeting of fibrosis, lymphocyte metabolism, and cellular therapies for cGVHD.
慢性移植物抗宿主病(cGVHD)是异基因造血干细胞移植后非复发发病率和死亡率的主要原因。小鼠cGVHD模型为美国食品药品监督管理局(FDA)近期批准的多种用于cGVHD患者二线和三线治疗的疗法的临床转化奠定了基础。然而,并非所有患者对这些疗法都有反应,而且在有反应的患者中,反应往往是部分的或短暂的。我们对cGVHD生物学的理解仍存在重大差距,这限制了我们开发可单独使用或联合使用以治疗cGVHD患者的更多且更精确疗法的能力。当前和未来针对尚未探索的疾病机制的临床前研究将阐明可用于改善cGVHD患者治疗效果的新途径。本综述重点关注来自cGVHD动物模型的临床前数据,特别强调(1)cGVHD基础生物学;(2)整合小鼠模型和人类样本的临床前数据用于临床转化的效用;以及(3)具有未来治疗潜力的新兴临床前研究领域,包括针对cGVHD的纤维化、淋巴细胞代谢和细胞疗法。
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