Challenges in GVHD and GVL after hematopoietic stem cell transplantation for myeloid malignancies.

In the past decade, major advances in the knowledge of mechanisms of graft-versus-host disease (GVHD) has allowed development of new treatments both for GVHD prophylaxis and treatment.

在过去的十年中，对移植物抗宿主病（GVHD）机制的深入了解，使得GVHD的预防和治疗新方法得以发展。

However, although successes did occur, failure did as well.

然而，尽管取得了一些成功，失败的情况也同样存在。

Reasons for failure can be linked either to incomplete understanding of the pathophysiology of GVHD, or, in some cases, to errors in the design of clinical trials.

失败的原因可以归咎于对移植物抗宿主病（GVHD）病理生理学的不完全理解，或者在某些情况下，归因于临床试验设计的错误。

Better GVHD prophylaxes and disease control have likely led to decreased nonrelapse mortality (NRM).

更好的移植物抗宿主病(GVHD)预防和疾病控制可能已经导致非复发死亡(NRM)的减少。

However, although NRM rates have decreased, rates of relapse of the original malignancy have not significantly improved.

然而，尽管NRM的比率已经下降，但原发恶性肿瘤复发的比率并没有显著改善。

Our current understanding of the biology of the graft-versus-leukemia (GVL) effect still lags behind that of GVHD, and treatment approaches to manipulate the GVL effect remain limited.

我们对移植物抗白血病（GVL）效应的生物学理解仍然落后于移植物抗宿主病（GVHD），并且操纵GVL效应的治疗手段仍然有限。

The reasons for such a lag are numerous, but improved knowledge of the biology of hematological malignancies open the gate to new developments, providing that we can better understand the interplay between the immune system with leukemic clones.

造成这种滞后的原因众多，但对血液恶性肿瘤生物学的深入了解打开了新发展的大门，前提是如果我们能更好地理解免疫系统与白血病克隆之间的相互作用。

From a therapeutical perspective, much attention has been paid to the results from randomized clinical trials and from a biological perspective on recent discoveries, especially in the human setting.

从治疗的角度来看，人们非常关注随机临床试验的结果以及在人类环境中的最新发现，特别是在生物学方面。

The objective of this perspective is to analyze what are the current challenges in the biology and treatment of GVHD and GVL and to provide a personal view on how some biological and therapeutic issues could be approached.

本文旨在分析当前在移植物抗宿主病（GVHD）和移植物抗白血病（GVL）的生物学和治疗方面所面临的挑战，并提供个人对如何解决一些生物学和治疗问题的看法。