Are mesenchymal stem cells still effective in acute GvHD management?

IF 1.4 4区医学 Q4 HEMATOLOGY Transfusion and Apheresis Science Pub Date : 2025-02-01 DOI:10.1016/j.transci.2024.104051

Bahar Uncu Ulu , Ipek Yonal Hindilerden , Tugce Nur Yigenoglu , Tarik Onur Tiryaki , Mehmet Ali Erkurt , Gulten Korkmaz , Sinem Namdaroglu , Elif Aksoy , Serdal Korkmaz , Mert Seyhan , Seda Yilmaz , Sevgi Kalayoglu Besisik , Mehmet Sinan Dal , Turgay Ulas , Fevzi Altuntas

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Abstract

Objective

Graft-versus-host disease (GvHD) is a common and serious complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT), significantly impacting transplant efficacy. In the treatment of GvHD, numerous therapeutic approaches have been explored, with mesenchymal stem cells (MSCs) emerging as a prominent immunomodulatory option. We aimed to evaluate efficacy and outcomes of using MSCs for steroid refractory acute GVHD (SR-aGvHD) management.

Materials and methods

We retrospectively analyzed data from 36 patients’ who received MSCs for treatment of SR-aGvHD following allo-HSCT between 2018 and 2024 from nine transplantation centers in Türkiye. The product consisted of umbilical cord-derived allogeneic MSCs, which were administered intravenously.

Results

Our cohort was at the median age of 39 years (range: 19–61 years), with aGvHD diagnosed at a median of two months after allo-HSCT. More than half of the patients (58.3 %) classified as high-grade aGvHD according to the Minnesota risk scoring. Cord blood-derived MSCs were administered at a median dose of 3.45 (range: 0.8–5) million MSCs/kg, with a median of 3th (range: 2–5) line treatment. The rate of responses exceeding partial response (PR) was approximately 20 % at the first month, increasing to 24 % at the second month. The six-month survival rate was 33 %, with 46 % of mortality attributed to sepsis and 12.5 % related to GvHD. Multivariate analysis indicated that increasing age (≥35 years) and lower platelet counts (≤75 x10⁹/L) were associated with higher mortality (p < 0.05).

Conclusion

MSC therapy has shown promising potential in improving response rates in aGvHD treatment, with efficacy enhanced by younger age and higher platelet counts.

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间充质干细胞在急性GvHD治疗中仍然有效吗？

目的：移植物抗宿主病（graft - anti -host disease, GvHD）是同种异体造血干细胞移植（allogenic hematopoietic stem cell transplantation, alloo - hsct）术后常见且严重的并发症，严重影响移植疗效。在GvHD的治疗中，已经探索了许多治疗方法，其中间充质干细胞（MSCs）成为一种突出的免疫调节选择。我们的目的是评估使用MSCs治疗类固醇难治性急性GVHD （SR-aGvHD）的疗效和结果。材料和方法：我们回顾性分析了2018年至2024年间来自日本9个移植中心的36名接受MSCs治疗同种异体造血干细胞移植后SR-aGvHD患者的数据。该产品由脐带来源的同种异体间充质干细胞组成，通过静脉注射。结果：我们的队列患者的中位年龄为39岁（范围：19-61岁），aGvHD的诊断中位时间为同种异体造血干细胞移植后2个月。根据明尼苏达风险评分，超过一半的患者（58.3 %）被分类为高级别aGvHD。脐带血来源的骨髓间充质干细胞的中位剂量为3.45（范围：0.8-5）万个骨髓间充质干细胞/kg，中位剂量为第3线（范围：2-5）。第一个月超过部分缓解（PR）的比率约为20 %，第二个月增加到24 %。六个月生存率为33. %，其中46%的死亡率归因于败血症，12. %与GvHD有关。多因素分析表明，年龄增加（≥35岁）和血小板计数降低（≤75 x109/L）与较高的死亡率相关（p ）。结论：MSC治疗在提高aGvHD治疗的应答率方面显示出良好的潜力，年龄越小、血小板计数越高，疗效越好。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transfusion and Apheresis Science 医学-血液学

CiteScore

3.60

自引率

5.30%

发文量

181

审稿时长

42 days

期刊介绍： Transfusion and Apheresis Science brings comprehensive and up-to-date information to physicians and health care professionals involved in the rapidly changing fields of transfusion medicine, hemostasis and apheresis. The journal presents original articles relating to scientific and clinical studies in the areas of immunohematology, transfusion practice, bleeding and thrombotic disorders and both therapeutic and donor apheresis including hematopoietic stem cells. Topics covered include the collection and processing of blood, compatibility testing and guidelines for the use of blood products, as well as screening for and transmission of blood-borne diseases. All areas of apheresis - therapeutic and collection - are also addressed. We would like to specifically encourage allied health professionals in this area to submit manuscripts that relate to improved patient and donor care, technical aspects and educational issues. Transfusion and Apheresis Science features a "Theme" section which includes, in each issue, a group of papers designed to review a specific topic of current importance in transfusion and hemostasis for the discussion of topical issues specific to apheresis and focuses on the operators'' viewpoint. Another section is "What''s Happening" which provides informal reporting of activities in the field. In addition, brief case reports and Letters to the Editor, as well as reviews of meetings and events of general interest, and a listing of recent patents make the journal a complete source of information for practitioners of transfusion, hemostasis and apheresis science. Immediate dissemination of important information is ensured by the commitment of Transfusion and Apheresis Science to rapid publication of both symposia and submitted papers.