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Pathogenesis of graft-versus-host disease

Nelson J Chao, MD
Section Editor
Robert S Negrin, MD
Deputy Editor
Alan G Rosmarin, MD


Graft-versus-host disease (GVHD) is a direct result of one of the principal functions of the immune system: the distinction of self from non-self. In an attempt to treat patients with severe and life-threatening illnesses (eg, malignancies treated with allogeneic hematopoietic cell transplantation), immune cells may be transplanted from a non-identical donor to the patient. These donor (eg, graft) cells may recognize patient (eg, host) cells as foreign, thereby initiating a graft-versus-host reaction which may lead to GVHD [1].

An understanding of the pathogenesis of this reaction has been obtained via the study of animal models of GVHD [2,3]. The basic requirements for the development of this disorder were recognized as early as the 1960s [4]. These include the following characteristics:

The graft must contain immunologically competent cells.

The host must possess transplantation antigens that are lacking in the graft, thereby appearing foreign to the graft; host cells subsequently stimulate donor cells via these specific antigenic determinants.

The host must be incapable of mounting a reaction against the graft for a period of time sufficient to allow graft cells to attack the host.

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Literature review current through: Nov 2017. | This topic last updated: Jun 07, 2017.
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