The Pathophysiology and Treatment of Graft-Versus-Host Disease: Lessons Learnt From Animal Models

Allogeneic hematopoietic cell transplantation (HCT) is a curative treatment for hematologic malignancies, bone marrow failure syndromes, and inherited immunodeficiencies and metabolic diseases. Graft-versus-host disease (GVHD) is the major life-threatening complication after allogeneic HCT. New insights into the pathophysiology of GVHD garnered from our understanding of the immunological pathways within animal models have been pivotal in driving new therapeutic paradigms in the clinic. Successful clinical translations include histocompatibility matching, GVHD prophylaxis using cyclosporine and methotrexate, posttransplant cyclophosphamide, and the use of broad kinase inhibitors that inhibit cytokine signaling (e.g. ruxolitinib). New approaches focus on naive T cell depletion, targeted cytokine modulation and the inhibition of co-stimulation. This review highlights the use of animal transplantation models to guide new therapeutic principles.

Automated summary

Allogeneic hematopoietic cell transplantation is an effective treatment for hematologic malignancies, but graft-versus-host disease remains a significant complication. Insights from animal models have led to new therapeutic approaches in the clinic, focusing on histocompatibility matching, GVHD prophylaxis, and novel inhibitors for cytokine signaling to improve patient outcomes.