학술논문
Umbilical Cord Mesenchymal Stromal Cells for Steroid-Refractory Acute Graft-versus-Host Disease.
Document Type
Article
Author
Donadel, Camila Derminio; Pires, Bruno Garcia; André, Nathália Cristine; Costa, Thalita Cristina Mello; Orellana, Maristela Delgado; Caruso, Sâmia Rigotto; Seber, Adriana; Ginani, Valéria Cortez; Gomes, Alessandra Araújo; Novis, Yana; Barros, George Maurício Navarro; Vilella, Neysimélia Costa; Martinho, Gláucia Helena; Vieira, Ana Karine; Kondo, Andrea Tiemi; Hamerschlak, Nelson; Filho, Jayr Schmidt; Xavier, Erick Menezes; Fernandes, Juliana Folloni; Rocha, Vanderson
Source
Subject
*STROMAL cells
*GRAFT versus host disease
*HEMATOPOIETIC stem cell transplantation
*ACUTE diseases
*UMBILICAL cord
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Language
ISSN
1424-8247
Abstract
Background: Steroid-refractory acute graft-vs.-host disease (SR-aGVHD) is a complication of allogeneic hematopoietic stem cell transplantation with a dismal prognosis and for which there is no consensus-based second-line therapy. Ruxolitinib is not easily accessible in many countries. A possible therapy is the administration of mesenchymal stromal cells (MSCs). Methods: In this retrospective study, 52 patients with severe SR-aGVHD were treated with MSCs from umbilical cord (UC-MSCs) in nine institutions. Results: The median (range) age was 12.5 (0.3–65) years and the mean ± SD dose (×106/kg) was 4.73 ± 1.3 per infusion (median of four infusions). Overall (OR) and complete response (CR) rates on day 28 were 63.5% and 36.6%, respectively. Children (n = 35) had better OR (71.5% vs. 47.1%, p = 0.12), CR (48.6% vs. 11.8%, p = 0.03), overall survival (p = 0.0006), and relapse-free survival (p = 0.0014) than adults (n = 17). Acute adverse events (all of them mild or moderate) were detected in 32.7% of patients, with no significant difference in children and adult groups (p = 1.0). Conclusions: UC-MSCs are a feasible alternative therapy for SR-aGVHD, especially in children. The safety profile is favorable. [ABSTRACT FROM AUTHOR]