Graft-versus-host disease: new directions for a persistent problem
GB Vogelsang and AD Hess
Johns Hopkins University School of Medicine, Bone Marrow Transplant Unit,
Baltimore, MD 21287-8985.
Graft-versus-host disease (GVHD) continues to be a major complication after
allogeneic bone marrow transplantation, especially with the increasing use
of unrelated and mismatched donors. Recently there has been renewed
scientific interest in GVHD because of the increasing appreciation of the
complexity of the immune responses seen in GVHD. Two basic aspects of the
immune response in GVHD, the immunologic target and the effector
mechanisms, are now more completely understood. First, the target of the
immune response in GVHD has long been felt to be histocompatibility
antigens possessed by the host, but not the donor. Recently, recognition of
self antigens in GVHD has been documented, showing that GVHD is more
complex than simple alloreactivity. Second, the effector mechanism in GVHD
was initially felt to be direct cytotoxicity by alloreactive T cells. It is
now recognized that cytokines play a central role in mediating many of the
clinical and experimental manifestations of GVHD. The development in these
two areas will be reviewed and the implications for clinical
transplantation discussed.
Volume 84,
Issue 7,
pp. 2061-2067,
10/01/1994
Copyright © 1994 by The American Society of Hematology
