The thymus in GVHD pathophysiology

A favorable outcome of allogeneic hematopoietic stem-cell transplantation (HSCT) depends on the complete reconstitution of the host's immune system. While recovery of peripheral T cells occurs in transplant recipients via both thymus-dependent and thymus-independent pathways, the regeneration of a population of phenotypically naive T cells with a broad T-cell receptor (TCR) repertoire relies entirely on the de novo generation of T cells in the thymus. However, preclinical models and clinical studies of allogeneic HSCT have identified the thymus as a target of graft-versus-host disease (GVHD). The present review focuses on recent insight into how GVHD affects thymic function and how this knowledge aides the design of new strategies to improve immune reconstitution following allogeneic HSCT.