Current Concepts and Advances in Graft-Versus-Host Disease Immunology

Annu Rev Immunol. 2021 Apr 26:39:19-49. doi: 10.1146/annurev-immunol-102119-073227. Epub 2021 Jan 11.


Worldwide, each year over 30,000 patients undergo an allogeneic hema-topoietic stem cell transplantation with the intent to cure high-risk hematologic malignancy, immunodeficiency, metabolic disease, or a life-threatening bone marrow failure syndrome. Despite substantial advances in donor selection and conditioning regimens and greater availability of allograft sources, transplant recipients still endure the morbidity and mortality of graft-versus-host disease (GVHD). Herein, we identify key aspects of acute and chronic GVHD pathophysiology, including host/donor cell effectors, gut dysbiosis, immune system and cytokine imbalance, and the interface between inflammation and tissue fibrosis. In particular, we also summarize the translational application of this heightened understanding of immune dysregulation in the design of novel therapies to prevent and treat GVHD.

Keywords: graft-versus-host disease; pathophysiology; prevention; regulation; therapy; tolerance.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Animals
  • Graft vs Host Disease* / etiology
  • Graft vs Host Disease* / therapy
  • Hematologic Neoplasms*
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Humans
  • Transplantation Conditioning
  • Transplantation, Homologous