Blood Journal
Leading the way in experimental and clinical research in hematology

Review Series: Advances in Hematopoietic Cell Transplantation
Acute graft-versus-host disease: a bench-to-bedside update

  1. Shernan G. Holtan1,
  2. Marcelo Pasquini2, and
  3. Daniel J. Weisdorf1
  1. 1Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN; and
  2. 2Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI

Abstract

Over the past 5 years, many novel approaches to early diagnosis, prevention, and treatment of acute graft-versus-host disease (aGVHD) have been translated from the bench to the bedside. In this review, we highlight recent discoveries in the context of current aGVHD care. The most significant innovations that have already reached the clinic are prophylaxis strategies based upon a refinement of our understanding of key sensors, effectors, suppressors of the immune alloreactive response, and the resultant tissue damage from the aGVHD inflammatory cascade. In the near future, aGVHD prevention and treatment will likely involve multiple modalities, including small molecules regulating immunologic checkpoints, enhancement of suppressor cytokines and cellular subsets, modulation of the microbiota, graft manipulation, and other donor-based prophylaxis strategies. Despite long-term efforts, major challenges in treatment of established aGVHD still remain. Resolution of inflammation and facilitation of rapid immune reconstitution in those with only a limited response to corticosteroids is a research arena that remains rife with opportunity and urgent clinical need.

  • Submitted January 29, 2014.
  • Accepted March 12, 2014.
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