The primacy of the gastrointestinal tract as a target organ of acute graft-versus-host disease: Rationale for the use of cytokine shields in allogeneic bone marrow transplantation

Geoffrey R. Hill, James L.M. Ferrara

Research output: Contribution to journalReview articlepeer-review

592 Scopus citations

Abstract

Acute graft-versus-host disease (GVHD), the major complication of allogeneic bone marrow transplantation (BMT), limits the application of this curative but toxic therapy. Studies of inflammatory pathways involved in GVHD in animals have shown that the gastrointestinal (GI) tract plays a major role in the amplification of systemic disease. Damage to the GI tract increases the translocation of inflammatory stimuli such as endotoxin, which promotes further inflammation and additional GI tract damage. The GI tract is therefore critical to the propagation of the 'cytokine storm' characteristic of acute GVHD. Experimental approaches to the prevention of GVHD include reducing the damage to the GI tract by fortification of the GI mucosal barrier through novel 'cytokine shields' such as IL-11 or keratinocyte growth factor. Such strategies have reduced GVHD while preserving a graft-versus- leukemia effect in animal models, and they now deserve formal testing in carefully designed clinical trials. (C) 2000 by The American Society of Hematology.

Original languageEnglish
Pages (from-to)2754-2759
Number of pages6
JournalBlood
Volume95
Issue number9
DOIs
StatePublished - 1 May 2000
Externally publishedYes

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