Clinical features, pathophysiology, and therapy of poor graft function post-allogeneic stem cell transplantation
Details
Publication Year 2022-03-22,Volume 6,Issue #6,Page 1947-1959
Journal Title
Blood Advances
Publication Type
Review
Abstract
Poor graft function (PGF), defined by the presence of multilineage cytopenias in the presence of 100% donor chimerism, is a serious complication of allogeneic stem cell transplant (alloSCT). Inducers or potentiators of alloimmunity such as cytomegalovirus reactivation and graft-versus-host disease are associated with the development of PGF, however, more clinical studies are required to establish further risk factors and describe outcomes of PGF. The pathophysiology of PGF can be conceptualized as dysfunction related to the number or productivity of the stem cell compartment, defects in bone marrow microenvironment components such as mesenchymal stromal cells and endothelial cells, or immunological suppression of post-alloSCT hematopoiesis. Treatment strategies focused on improving stem cell number and function and microenvironment support of hematopoiesis have been attempted with variable success. There has been limited use of immune manipulation as a therapeutic strategy, but emerging therapies hold promise. This review details the current understanding of the causes of PGF and methods of treatment to provide a framework for clinicians managing this complex problem.
Keywords
Humans; Endothelial Cells; *Graft vs Host Disease/etiology/therapy; *Hematopoietic Stem Cell Transplantation/adverse effects; Transplantation, Homologous/adverse effects
Department(s)
Haematology
PubMed ID
34492685
Open Access at Publisher's Site
https://doi.org/10.1182/bloodadvances.2021004537
Terms of Use/Rights Notice
Refer to copyright notice on published article.


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