急性移植物抗宿主病的预防及治疗策略

 造血干细胞移植已经成为治疗恶性血液病及一些实体肿瘤的主要手段，但一些并发症影响了移植效果，急性移植物抗宿主病（aGVHD）是移植后的主要并发症和主要致死原因，Ⅱ度以上aGVHD死亡率高达50 %。目前主要的预防方法有抑制T细胞激活和增殖，减少移植物中T细胞含量，减低预处理剂量。一线治疗的主要方法是激素治疗，但是只有1／4的患者对一线治疗有完全反应，激素抵抗的患者对二线治疗的反应率只有30 %～50 %，二线治疗包括单克隆抗体、化疗药物和细胞因子抑制剂等，而二线治疗方法破坏了免疫系统，且增高了感染率。因此，需要一种新的预防aGVHD的方法。现主要综述新的免疫调节剂来预防和治疗aGVHD。

Current prevention and therapies in acute GVHD

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the major curative treatment for patients with malignant hematologic diseases. However, a number of serious complications limits successful outcomes. Acute graft-versus-host disease(GVHD) is a major cause of death following allo-HSCT.The mortality rate is 50 % in Ⅱ -Ⅳ aGVHD. At present, the major prevention methods conclude inhibiting T cell activation and proliferation, depleting of T cell in graft, and decreasing the dose of preconditioning. And only one quarter of these patients will have a complete response to first-line corticosteroid therapy. Patients with steroid resistant acute GVHD require second-line therapy to which the response rate is only 30 %-50 %.Second-line therapies including monoclone antibody, chemotherapy and cytokine inhibitor were used. Secondline options can impair immune reconstitution and increase the risk for infection. Therefore, novel approaches to prevent and treat GVHD are critically needed. This work will review novel immuno-modulatory therapy currently being employed both for the prevention and treatment of GVHD.