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Controversies and expectations for the prevention of GVHD: A biological and clinical perspective

Severe acute and chronic graft versus host disease (GVHD) remains a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation. Historically, cord blood and matched sibling transplantation has been associated with the lowest rates of GVHD. Newer methods have modified...

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Autores principales: Watkins, Benjamin, Williams, Kirsten M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9726707/
https://www.ncbi.nlm.nih.gov/pubmed/36505500
http://dx.doi.org/10.3389/fimmu.2022.1057694
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author Watkins, Benjamin
Williams, Kirsten M.
author_facet Watkins, Benjamin
Williams, Kirsten M.
author_sort Watkins, Benjamin
collection PubMed
description Severe acute and chronic graft versus host disease (GVHD) remains a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation. Historically, cord blood and matched sibling transplantation has been associated with the lowest rates of GVHD. Newer methods have modified the lymphocyte components to minimize alloimmunity, including: anti-thymocyte globulin, post-transplant cyclophosphamide, alpha/beta T cell depletion, and abatacept. These agents have shown promise in reducing severe GVHD, however, can be associated with increased risks of relapse, graft failure, infections, and delayed immune reconstitution. Nonetheless, these GVHD prophylaxis strategies have permitted expansion of donor sources, especially critical for those of non-Caucasian decent who previously lacked transplant options. This review will focus on the biologic mechanisms driving GVHD, the method by which each agent impacts these activated pathways, and the clinical consequences of these modern prophylaxis approaches. In addition, emerging novel targeted strategies will be described. These GVHD prophylaxis approaches have revolutionized our ability to increase access to transplant and have provided important insights into the biology of GVHD and immune reconstitution.
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spelling pubmed-97267072022-12-08 Controversies and expectations for the prevention of GVHD: A biological and clinical perspective Watkins, Benjamin Williams, Kirsten M. Front Immunol Immunology Severe acute and chronic graft versus host disease (GVHD) remains a major cause of morbidity and mortality after allogeneic hematopoietic cell transplantation. Historically, cord blood and matched sibling transplantation has been associated with the lowest rates of GVHD. Newer methods have modified the lymphocyte components to minimize alloimmunity, including: anti-thymocyte globulin, post-transplant cyclophosphamide, alpha/beta T cell depletion, and abatacept. These agents have shown promise in reducing severe GVHD, however, can be associated with increased risks of relapse, graft failure, infections, and delayed immune reconstitution. Nonetheless, these GVHD prophylaxis strategies have permitted expansion of donor sources, especially critical for those of non-Caucasian decent who previously lacked transplant options. This review will focus on the biologic mechanisms driving GVHD, the method by which each agent impacts these activated pathways, and the clinical consequences of these modern prophylaxis approaches. In addition, emerging novel targeted strategies will be described. These GVHD prophylaxis approaches have revolutionized our ability to increase access to transplant and have provided important insights into the biology of GVHD and immune reconstitution. Frontiers Media S.A. 2022-11-23 /pmc/articles/PMC9726707/ /pubmed/36505500 http://dx.doi.org/10.3389/fimmu.2022.1057694 Text en Copyright © 2022 Watkins and Williams https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Watkins, Benjamin
Williams, Kirsten M.
Controversies and expectations for the prevention of GVHD: A biological and clinical perspective
title Controversies and expectations for the prevention of GVHD: A biological and clinical perspective
title_full Controversies and expectations for the prevention of GVHD: A biological and clinical perspective
title_fullStr Controversies and expectations for the prevention of GVHD: A biological and clinical perspective
title_full_unstemmed Controversies and expectations for the prevention of GVHD: A biological and clinical perspective
title_short Controversies and expectations for the prevention of GVHD: A biological and clinical perspective
title_sort controversies and expectations for the prevention of gvhd: a biological and clinical perspective
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9726707/
https://www.ncbi.nlm.nih.gov/pubmed/36505500
http://dx.doi.org/10.3389/fimmu.2022.1057694
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