Chapter 16. The Pathophysiology of Graft-Versus-Host Disease

  1. Frederick R. Appelbaum MD Member Director Professor Head3,4,
  2. Stephen J. Forman MD Director Staff Physician5,6,
  3. Robert S. Negrin MD Professor of Medicine Chief7 and
  4. Karl G. Blume MD, FACP Emeritus Professor of Medicine7,8
  1. James L. M. Ferrara MD Professor of Medicine and Pediatrics Director1 and
  2. Joseph H. Antin MD Professor of Medicine2

Published Online: 5 MAR 2009

DOI: 10.1002/9781444303537.ch16

Thomas' Hematopoietic Cell Transplantation: Stem Cell Transplantation, Fourth Edition

Thomas' Hematopoietic Cell Transplantation: Stem Cell Transplantation, Fourth Edition

How to Cite

Ferrara, J. L. M. and Antin, J. H. (2009) The Pathophysiology of Graft-Versus-Host Disease, in Thomas' Hematopoietic Cell Transplantation: Stem Cell Transplantation, Fourth Edition (eds F. R. Appelbaum, S. J. Forman, R. S. Negrin and K. G. Blume), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444303537.ch16

Editor Information

  1. 3

    Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA

  2. 4

    Division of Medical Oncology, University of Washington School of Medicine, Seattle, Washington, USA

  3. 5

    Department of Hematology and Hematopoietic Cell Transplantation, Duarte, California, USA

  4. 6

    Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California, USA

  5. 7

    Division of Blood and Marrow Transplantation, Stanford University, Stanford, California, USA

  6. 8

    Division of Bone Marrow Transplantation, Department of Medicine, Stanford University, School of Medicine, Stanford, California, USA

Author Information

  1. 1

    Blood and Marrow Transplantation Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA

  2. 2

    Harvard Medical School, Dana Farber Cancer Institute, Boston, MA, USA

Publication History

  1. Published Online: 5 MAR 2009
  2. Published Print: 27 FEB 2009

ISBN Information

Print ISBN: 9781405153485

Online ISBN: 9781444303537



  • pathophysiology of graft-versus-host disease;
  • acute GVHD pathophysiology - three-step model;
  • effects of conditioning in hematopoietic cell transplantation;
  • regulatory T cells;
  • toll-like receptors and innate immunity;
  • modulation of donor T cells;
  • reduced T-cell proliferation;
  • GVHD - major barrier to wider application of allogeneic HCT


This chapter contains sections titled:

  • Acute GVHD pathophysiology: a three-step model

  • Step 1: Effects of conditioning in hematopoietic cell transplantation

  • Step 2: Donor T-cell activation and cytokine secretion

  • Cytokine secretion by donor T cells

  • Step 3: Cellular and inflammatory effectors

  • Cellular effectors

  • Inflammatory effectors

  • Toll-like receptors and innate immunity

  • GVHD prevention: from animal models to clinical practice

  • Step 1: Reduced-intensity conditioning regimens

  • Step 2: Modulation of donor T cells

  • Reduced T-cell activation

  • Reduced T-cell proliferation

  • Step 3: Blockade of inflammatory stimulation and effectors

  • Chronic GVHD

  • Conclusion

  • References