Acute Graft-versus-Host-Disease Other Than Typical Targets: Between Myths and Facts

Donor alloreactivity after allogeneic hematopoietic stem cell transplantation results in graft-versus-host reaction (GVHR) that may affect different organs. While skin, liver, and gastrointestinal tract are well-recognized targets of such alloreactivity early after transplant, commonly identified as acute graft-versus-host-disease (aGVHD), there is accumulating evidence from the literature that early GVHR may be directed also against other tissues. In particular, organs such as kidney, bone marrow, central nervous system, and lungs may be involved in patients experiencing aGVHD, but whether these sites represent targets or collateral damages of donor alloreactivity is matter of debate. This review summarizes the current knowledge, the potential applications, and the clinical relevance of GFHR in nontypical target organs during aGVHD. The objective of this article is to lay the basis for future efforts aiming at including these organs in grading and management of aGVHD. (C) 2020 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Automated summary

Donor alloreactivity after transplantation can lead to graft-versus-host reaction (GVHR), affecting various organs beyond the well-recognized skin, liver, and gastrointestinal tract. Organs like the kidney, bone marrow, central nervous system, and lungs may also be involved, sparking debate on whether they are targets or collateral damage of the alloreactivity.