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Lookup NU author(s): Professor Anne Dickinson
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Graft-versus-host disease (GVHD) is the most serious complication following bone marrow transplantation, with an incidence of 40-60%. The disease can be fatal in 50% of cases, even in patients receiving marrow from an HLA identical sibling. Several assays have been developed to try to predict the development of GVHD, including mixed lymphocyte culture reaction, cytotoxic T lymphocyte precursor, and helper T lymphocyte precursor frequency assays. This review describes an in vitro skin explant model which has been used since 1988 for both predicting acute GVHD in HLA identical sibling bone marrow transplantation and studying the pathophysiology of the disease. The model involves sensitising donor lymphocytes in vitro in a primary mixed lymphocyte reaction and then evaluating the secondary response on patient skin biopsies by grading the graft-versus-host reactivity (grades I-IV) histopathologically. From analysis of collective data the model is a clear predictor of GVHD and superior to the other assays widely used, with a correlation of 82% with clinical outcome. The skin explant model allows the investigator to study the pathogenesis of GVHD. The cytokines TNFα and IFNγ are shown to be important mediators of cellular damage in graft-versus-host reactions. Recent work has also involved using the model to study the alloreactivity of cord blood. The model is currently being assessed in several bone marrow transplantation centres in Europe on different patient groups including those who receive marrow from haploidentical and matched unrelated donors.
Author(s): Sviland L, Dickinson AM
Publication type: Review
Publication status: Published
Journal: Journal of Clinical Pathology
Year: 1999
Volume: 52
Issue: 12
Pages: 910-913
Print publication date: 01/12/1999
ISSN (print): 0021-9746
ISSN (electronic): 1472-4146
URL: http://dx.doi.org/10.1136/jcp.52.12.910
DOI: 10.1136/jcp.52.12.910
PubMed id: 10711254
