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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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Immunology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2022.1057694/full |
| _version_ | 1811216488767422464 |
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| author | Benjamin Watkins Kirsten M. Williams |
| author_facet | Benjamin Watkins Kirsten M. Williams |
| author_sort | Benjamin Watkins |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-12T06:39:56Z |
| format | Article |
| id | doaj.art-0d2bc41b99f74e37a56e58215398841c |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-04-12T06:39:56Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-0d2bc41b99f74e37a56e58215398841c2022-12-22T03:43:45ZengFrontiers Media S.A.Frontiers in Immunology1664-32242022-11-011310.3389/fimmu.2022.10576941057694Controversies and expectations for the prevention of GVHD: A biological and clinical perspectiveBenjamin WatkinsKirsten M. WilliamsSevere 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.https://www.frontiersin.org/articles/10.3389/fimmu.2022.1057694/fullGVHDGVHD prophylaxiscontroversyGVHD biologyGVHD therapies |
| spellingShingle | Benjamin Watkins Kirsten M. Williams Controversies and expectations for the prevention of GVHD: A biological and clinical perspective Frontiers in Immunology GVHD GVHD prophylaxis controversy GVHD biology GVHD therapies |
| 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 | GVHD GVHD prophylaxis controversy GVHD biology GVHD therapies |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2022.1057694/full |
| work_keys_str_mv | AT benjaminwatkins controversiesandexpectationsforthepreventionofgvhdabiologicalandclinicalperspective AT kirstenmwilliams controversiesandexpectationsforthepreventionofgvhdabiologicalandclinicalperspective |