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Hematopoietic Cell Transplantation in Children with Cancer pp 57–75Cite as

Graft Versus Host Disease: From Basics to the Clinic

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Part of the book series: Pediatric Oncology ((PEDIATRICO))

Abstract

Allogeneic transplantation, the transfer of tissues from one individual to another, is complicated by the exquisite specificity and cellular and mechanistic diversity of the immune system. Thus, recognition of donor tissues by host immune cells (host versus graft) and host tissues by donor immune cells (graft versus host, GVH) is an obligate event after hematopoietic cell transplantation (HCT), although there is dramatic variation in the manifestations of these responses. Despite many advances over the last several decades, GVH disease (GVHD) remains a significant barrier to successful HCT. GVHD occurs in both an acute and chronic form, may be of limited or unlimited duration and remains a major cause of morbidity and mortality. The pathophysiology and manifestations of acute and chronic GVHD are unique, and the assessment and management of these conditions are quite different. GVHD remains the major contributor to death in 15–30 % of patients undergoing HCT and a cause of morbidity in approximately half of patients. The morbidity of GVHD is of particular concern in pediatrics, where HCT for nonmalignant diseases is more common and the contribution of GVHD to the risk-benefit equation must be particularly carefully considered.

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Authors and Affiliations

  1. Departments of Radiation Oncology and Pediatric Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Eva C. Guinan MD

  2. Harvard Medical School, Boston, MA, USA

    Eva C. Guinan MD

  3. Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota Medical School, 420 Delawar Sr. S.E., Minneapolis, MN, USA

    Margaret L. MacMillan MD

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  1. Eva C. Guinan MD
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Correspondence to Eva C. Guinan MD .

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  1. University of Cincinnati, Cincinnati, Ohio, USA

    Franklin O. Smith

  2. George Washington University, Washington, Washington, USA

    Gregory H. Reaman

  3. Division of Hematology/Oncology, Dept. of Internal Medicine, University of Cincinnati College of Medicine, Madeira, Ohio, USA

    Judy M. Racadio

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Guinan, E.C., MacMillan, M.L. (2014). Graft Versus Host Disease: From Basics to the Clinic. In: Smith, F., Reaman, G., Racadio, J. (eds) Hematopoietic Cell Transplantation in Children with Cancer. Pediatric Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39920-6_4

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