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Review
. 2011 Nov;18(6):408-13.
doi: 10.1097/MOH.0b013e32834b6196.

Have we improved in preventing and treating acute graft-versus-host disease?

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Review

"VSports在线直播" Have we improved in preventing and treating acute graft-versus-host disease?

Lia Perez et al. Curr Opin Hematol. 2011 Nov.

Abstract

Purpose of review: Acute graft-versus-host disease (GVHD) is a considerable source of morbidity and mortality following allogeneic hematopoietic cell transplantation (HCT). Accordingly, progress in the prevention and primary therapy of this complication is needed to improve patient outcomes. VSports手机版.

Recent findings: Guided by insights into acute GVHD pathogenesis, investigators have explored novel cellular and pharmacologic approaches to acute GVHD prevention that demonstrates promise. Although pan-T-cell depletion has reduced GVHD, novel strategies that selectively deplete alloreactive T cells or modulate the balance of effector T cells and regulatory T cells offer promise to selectively abrogate acute GVHD while retaining protection from primary disease relapse and infectious complications. V体育安卓版.

Summary: Divergent approaches in the primary therapy of acute GVHD have explored both combination approaches with standard dose glucocorticoids and additional immunosuppressive agents and conversely steroid-sparing approaches including topical agents such as beclomethasone or sirolimus as a steroid-free approach to acute GVHD therapy. Mature results of high-quality clinical trials are needed to determine the optimal therapy that results in effective control of the syndrome and limited toxicity. These complementary outcomes represent the therapeutic goal for future investigation in acute GVHD therapy. V体育ios版.

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Figures (VSports)

Figure 1
Figure 1
Cumulative incidence of chronic GVHD and survival outcomes following post-HCT high dose cyclophosphamide (reprinted from Luznik, et al, Blood 2010)
Figure 2
Figure 2
Response to sirolimus as sole primary therapy of acute GVHD (reprinted from Pidala, et al, Haematologica, 2011)

References

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    1. Ratanatharathorn V, Nash RA, Przepiorka D, et al. Phase III study comparing methotrexate and tacrolimus (prograf, FK506) with methotrexate and cyclosporine for graft-versus-host disease prophylaxis after HLA-identical sibling bone marrow transplantation. Blood. 1998;92:2303–2314. - PubMed
    1. Brunstein CG, Miller JS, Cao Q, et al. Infusion of ex vivo expanded T regulatory cells in adults transplanted with umbilical cord blood: safety profile and detection kinetics. Blood. 2011;117:1061–1070. Brunstein, et al have demonstrated the feasibility of donor Treg expansion and safety of infusion of such cells in the setting of umbilical cord blood transplantation. - PMC - PubMed
    1. Gatza E, Rogers CE, Clouthier SG, et al. Extracorporeal photopheresis reverses experimental graft-versus-host disease through regulatory T cells. Blood. 2008;112:1515–1521. - PMC - PubMed
    1. Shaughnessy PJ, Bolwell BJ, van Besien K, et al. Extracorporeal photopheresis for the prevention of acute GVHD in patients undergoing standard myeloablative conditioning and allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant. 2010;45:1068–1076. - "VSports在线直播" PMC - PubMed

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