Articles

Acute graft-versus-host disease: diagnosis, pathophysiology and prevention

BJH - volume 11, issue 4, june 2020

B. Vandenhove PhD student, L. Canti PhD student, H. Schoemans MD, PhD, Y. Beguin MD, PhD, F. Baron MD, PhD, E. Willems MD, PhD, C. Graux MD, PhD, T. Kerre MD, PhD, S. Servais MD, PhD

SUMMARY

Acute graft-versus-host disease (aGVHD) remains a severe complication after allogeneic stem cell transplantation (alloHCT). It is a disregulated immune process, during which the immune cells of the donor attack the healthy tissues in the immunocompromised host. Over the past two decades, progress in understanding its pathophysiology have helped redefine aGVHD reactions and clinical presentations. Typically, the disease presents with serious inflammatory lesions mainly in the skin, gut and liver. Its severity is assessed by gathering clinical signs and dysfunctions of each organ. Despite standard prophylaxis regimens, aGVHD still occurs in approximately 30–60% of transplanted patients and remains a major cause of transplant-related morbidity and mortality. Hence, there is an urgent need for optimising preventive strategies. In this review, we give insights on how to make an accurate diagnosis and scoring assessment of aGVHD, propose a short overview of the current knowledge about its immunobiology and discuss the current and developing strategies for prevention.

(BELG J HEMATOL 2020;11(4):159–173)

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