Biology and management of acute graft-versus-host disease

Abstract

Acute GvHD is a multifactorial complex pathophysiology that integrates adaptive and innate immunity in a maladaptive fashion. It is best considered an exaggeration of normal physiologic mechanisms wherein the donor immune system attempts to rid the donor of antigens that are intrinsic to the donor. The inflammatory process that follows has the benefit of providing an anti-cancer effect for many diseases, but unfortunately the nonspecific nature of the inflammation can result in disability and death. As we understand the physiology of GvHD more completely, it behooves us to develop strategies to control it that are more subtle than massive doses of corticosteroids. By identifying completely the elements of the immune response that are responsible for GvHD, the challenge of the next decade will be to adjust our therapy to provide adequate control of the underlying malignancy without making the patient subject either to the damaging effects of GvHD per se or the ravages of immunologic failure.